Anaesthesia for hip fracture surgery in adults

  • Review
  • Intervention


  • Martyn J Parker,

    Corresponding author
    1. Peterborough and Stamford Hospitals NHS Foundation Trust, Department of Orthopaedics, Peterborough, Cambridgeshire, UK
    • Martyn J Parker, Department of Orthopaedics, Peterborough and Stamford Hospitals NHS Foundation Trust, Peterborough City Hospital, CBU PO Box 211, Bretton Gate, Peterborough, Cambridgeshire, PE3 9GZ, UK.

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  • Helen HG Handoll,

    1. Teesside University, Health and Social Care Institute, Middlesbrough, Tees Valley, UK
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  • Richard Griffiths

    1. Peterborough and Stamford Hospitals NHS Foundation Trust, Department of Anaesthesia, Peterborough, Cambridgeshire, UK
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The majority of people with hip fracture are treated surgically, requiring anaesthesia.


To compare different types of anaesthesia for surgical repair of hip fractures (proximal femoral fractures) in adults.

Search methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group specialised register (November 2003), MEDLINE (1996 to February week 2 2004), EMBASE (1988 to 2004 week 10) and reference lists of relevant articles.

Selection criteria

Randomised and quasi-randomised trials comparing different methods of anaesthesia for hip fracture surgery in adults. The primary focus of this review was the comparison of regional (spinal or epidural) anaesthesia versus general anaesthesia. The use of nerve blocks preoperatively or in conjunction with general anaesthesia is evaluated in another review. The primary outcome was mortality.

Data collection and analysis

Two reviewers independently assessed trial quality and extracted data.

Main results

Twenty two trials, involving 2567 predominantly female and elderly patients, comparing regional anaesthesia with general anaesthesia were included. All trials had methodological flaws and many do not reflect current anaesthetic practice. Pooled results from eight trials showed regional anaesthesia to be associated with a decreased mortality at one month (56/811 (6.9%) versus 86/857 (10.0%)); however, this was of borderline statistical significance (relative risk (RR) 0.69, 95% confidence interval (CI) 0.50 to 0.95). The results from six trials for three month mortality were not statistically significant, although the confidence interval does not exclude the possibility of a clinically relevant reduction (86/726 (11.8%) versus 98/765 (12.8%), RR 0.92, 95% CI 0.71 to 1.21). The reduced numbers of trial participants at one year, coming exclusively from two trials, preclude any useful conclusions for long-term mortality (80/354 (22.6%) versus 78/372 (21.0%), RR 1.07, 95% CI 0.82 to 1.41).

Regional anaesthesia was associated with a reduced risk of deep venous thrombosis (39/129 (30%) versus 61/130 (47%); RR 0.64, 95% CI 0.48 to 0.86). However, this finding is insecure due to possible selection bias in the subgroups in whom this outcome was measured. Regional anaesthesia was also associated with a reduced risk of acute postoperative confusion (11/117 (9.4%) versus 23/120 (19.2%), RR 0.50, 95% CI 0.26 to 0.95).

There was insufficient evidence to draw any conclusions from a further four included trials, involving a total of 179 participants, which compared other methods of anaesthesia (a 'light' general with spinal anaesthesia; intravenous ketamine; nerve blocks).

Authors' conclusions

Overall, there was insufficient evidence available from trials comparing regional versus general anaesthesia to rule out clinically important differences. Regional anaesthesia may reduce acute postoperative confusion but no conclusions can be drawn for mortality or other outcomes.

Plain language summary

Anaesthesia for hip fracture surgery in adults

The majority of people with hip fracture are elderly and are treated surgically, which requires anaesthesia. The most common types of anaesthesia are 'general' and 'spinal'. General anaesthesia, which involves a loss of consciousness, typically includes inhalation of gases. Spinal (regional) anaesthesia involves an injection into the space around the spinal cord, to prevent pain in the involved limb. There was less mental confusion immediately after surgery in people given spinal anaesthesia, but there was not enough evidence to tell if regional anaesthesia was superior for any other outcome.