title: Peripheral nerve blocks with sedation using propofol and alfentanil target-controlled infusion for hip fracture surgery: a review of 6 years in use.
abstract: OBJECTIVE
  Over the last 6 years, our center has introduced a novel technique combining peripheral nerve blocks (femoral and lateral femoral cutaneous nerves) with sedation using propofol with alfentanil target-controlled infusion for hip fracture surgery. The purpose of this review was to identify if adverse outcomes (of mortality and length of stay) were associated with its introduction compared to spinal or general anesthesia.
  
  
  METHODS
  Retrospective data collection from hospital fracture database. Data were analyzed using Cox regression (adjusted for age, sex, and American Society of Anesthesiologists grade) to compare survival and length of stay data across the different anesthetic techniques used for hip fracture surgery.
  
  
  RESULTS
  This technique was used in 472 (20%) of 2360 hip fractures. There was no significant difference between peripheral nerve blocks with propofol/alfentanil sedation/analgesia for mortality up to 120days (hazard ratio, 0.76; 95% confidence interval, 0.54-1.06; P=.11) and length of stay (hazard ratio, 1.03; 95% confidence interval, 0.91-1.17; P=.63) when compared to the other anesthetic techniques of spinal and general anesthesia.
  
  
  CONCLUSIONS
  This novel technique does not appear to be associated with adverse mortality or length of stay after hip fracture surgery.
authors.affiliation: Clinical Fellow Regional Anaesthesia, LHSC, University Hospital, Windermere Road, London, ON, Canada. Electronic address: djohn015@gmail.com.
authors.forename: D F
authors.initials: DF
authors.lastname: Johnston
authors.affiliation: Consultant Anaesthetist, The Ulster Hospital, Dundonald, Northern Ireland. Electronic address: michael.stafford@setrust.hscni.net.
authors.forename: M
authors.initials: M
authors.lastname: Stafford
authors.affiliation: Consultant Anaesthetist, The Ulster Hospital, Dundonald, Northern Ireland. Electronic address: maurice.mckinney@setrust.hscni.net.
authors.forename: M
authors.initials: M
authors.lastname: McKinney
authors.affiliation: Consultant Anaesthetist, The Ulster Hospital, Dundonald, Northern Ireland. Electronic address: rachel.deyermond@setrust.hscni.net.
authors.forename: R
authors.initials: R
authors.lastname: Deyermond
authors.affiliation: Trauma Coordinator, The Ulster Hospital, Dundonald, Northern Ireland. Electronic address: katharine.dane@setrust.hscni.net.
authors.forename: K
authors.initials: K
authors.lastname: Dane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015760:Alfentanil / Q000008:administration & dosage*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods; D000775:Anesthesia, Spinal / Q000009:adverse effects / Q000379:methods; D016292:Procedural Sedation / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005267:Femoral Nerve; D005593:Fracture Fixation, Internal / Q000379:methods; D062785:Hemiarthroplasty / Q000379:methods; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007262:Infusions, Intravenous; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D009407:Nerve Block / Q000009:adverse effects / Q000379:methods*; D015742:Propofol / Q000008:administration & dosage*; D012189:Retrospective Studies; D016019:Survival Analysis
chemical_list: D006993:Hypnotics and Sedatives; D015760:Alfentanil; D015742:Propofol
keywords: Femoral nerve block; Hip fracture; Propofol; Sedation; Target controlled infusion