Combined sciatic-paravertebral nerve block vs. general anaesthesia for fractured hip of the elderly.

Sixty elderly patients scheduled for surgical hip fracture repair were given the choice of either general isoflurane anaesthesia (n = 30) or a nerve stimulator guided combined sciatic-paravertebral nerve block (n = 30). The incidence of intraoperative hypotension and the need for postoperative admission to the intensive care unit/high dependency unit (ICU/HDU) within 48 hours postoperatively were recorded. No differences in patient characteristics, ASA class or concomitant disease status were detected between the two study groups. Both the incidence of intraoperative hypotension (0/30 vs. 11/30, p < 0.001) and the postoperative need for ICU/HDU admission (0/30 vs. 11/30, p < 0.001) was significantly reduced in patients treated with a combined sciatic-paravertebral nerve block compared to patient receiving general anaesthesia. The length of hospital stay was also found to be shorter for patient in the regional anaesthesia group [mean 6.7 days (SD 2.3) vs. 13.6 days (SD 6.1)]. The described technique appears to be an attractive alternative method to handle proximal fractures of the femur in the elderly, especially in a situation with limited ICU/HDU availability.