A retrospective study on the application of unilateral epidural anesthesia in older patients with hip fracture

We analyzed data from older patients (≥ 65 years) with hip fractures who underwent surgical treatment with unilateral epidural anesthesia (UEA) or combined spinal-epidural anesthesia (CSEA) to compare perioperative outcomes between the two anesthetic techniques.

One hundred and six older patients with hip fractures who underwent surgery were retrospectively analyzed and stratified into UEA and CSEA groups. The clinical variables investigated included ephedrine use, preanesthetic and postanesthetic hemodynamic heart rate, oxygen saturation changes at 5, 10, 15, and 20 min, complications, duration of hospital stay, mortality, and lower limb function.

The duration of anesthesia in the CSEA group was shorter than in the UEA group (P < 0.05). There were no significant differences in sensory block duration or recovery (P > 0.05). Systolic blood pressure was significantly higher in the UEA group than in the CSEA group at all post‑anesthesia time points (5, 10, 15, and 20 min) (all P < 0.05). There were no significant differences in vasopressor use, hypotension, urinary retention, or phantom limb sensations between the two groups (all adjusted P > 0.05). No significant differences were found in sedative use, postoperative complications, duration of hospital stay, critical care admission, mortality, or lower limb function (P > 0.05).

Compared with CSEA, UEA was associated with more stable hemodynamics. Despite a longer induction time, UEA represents a viable anesthetic option for older patients with hip fractures. These findings are exploratory and hypothesis-generating due to the retrospective, non-randomized design. Further prospective studies are needed to confirm these results.