[Application effect of dural puncture epidural anesthesia in elderly patients undergoing hip fracture surgery]

Objective: To analyze the application effect of dural puncture epidural anesthesia (DPE) in elderly patients undergoing hip fracture surgery. Methods: Elderly patients scheduled for elective unilateral hip fracture surgery at the Sir Run Run Hospital Affiliated to Nanjing Medical University from May to December 2024 were prospectively enrolled. They were randomly divided into the DPE group and the epidural anesthesia (EA) group (61 cases each) using a random number table. The two groups were compared in terms of the incidence of intraoperative incomplete block, time to achieve the T₁₀ sensory blockade level, the lowest mean arterial pressure (MAP) within 15 minutes after anesthesia, vasoactive drug usage rate, time for Bromage score to recovery to 0, visual analogue scale (VAS) of pain score at 6 and 12 h postoperatively, surgeon satisfaction, and incidence of anesthesia-related adverse events. Results: The DPE group had a median age of 69 (67, 72) years, with 36 males and 25 females, while the EA group had a median age of 69 (67, 72) years, with 38 males and 23 females. There were no significant differences between the two groups in age, gender, body mass index, American Society of Anesthesiologists classification, or types of comorbidities (all P>0.05). The DPE group had a lower incidence of incomplete blockade [11.5% (7/61) vs 27.9% (17/61)], a shorter time to achieve the T₁₀ sensory blockade level [(443±38) s vs (559±47) s], and higher surgeon satisfaction [10(9, 11) scores vs 9(9, 10) scores] compared to the EA group (all P<0.05). There were no significant differences between the two groups in the lowest MAP within 15 minutes after anesthesia, vasoactive drug usage rate, time for Bromage score to return to 0, postoperative VAS of pain scores at 6 and 12 h, or incidence of anesthesia-related adverse events (all P>0.05). Conclusion: Compared to traditional EA, DPE offers superior block quality and faster onset of anesthesia in elderly patients undergoing hip fracture surgery without compromising hemodynamic stability or prolonging motor block.