Résumé de l'étude

Sixty patients with proximal femur fractures undergoing intramedullary nailing were randomized to receive selective spinal anesthesia or peripheral nerve blocks involving femoral, lateral femoral-cutaneous, obturator, and sciatic nerve blocks. The primary outcome of interest was intraoperative hemodynamic instability, defined as mean arterial pressure <65 mmHg for at least 5 minutes. Secondary outcomes included bradycardia, postoperative adverse events, postoperative pain scores, time to mobilization, analgesic rescue requirements, and length of hospital stay. Outcomes were assessed intraoperatively and throughout hospitalization, including postoperative evaluations up to 24 hours. Overall, the results of the study revealed that peripheral nerve blocks were associated with significantly lower rates of intraoperative hemodynamic instability and bradycardia compared with selective spinal anesthesia. Peripheral nerve blocks also demonstrated lower postoperative delirium rates and slightly improved postoperative pain control, while maintaining similar surgical conditions and complication rates. These findings suggest that peripheral nerve blocks may represent a safe and effective alternative to selective spinal anesthesia in elderly patients with proximal femur fractures.