Evolving Strategies in Anesthetic Management of Femur Fractures

A randomized controlled trial in patients with proximal femur fractures directly compared peripheral nerve blocks to spinal anesthesia and found markedly lower intraoperative hemodynamic instability with peripheral nerve blocks (16.7% vs 43.4%). This magnitude of risk reduction positions peripheral nerve blocks as a clinically meaningful safety alternative for many acute femur fracture cases.

Immediate postoperative analgesia favored peripheral nerve blocks by small margins at standard early time points (end of surgery, 6h, and 24h), but differences in pain scores were minimal and did not reach clinical significance. Both techniques provided acceptable intraoperative analgesia with similar rescue analgesic requirements in the first 24 hours.

Peripheral nerve blocks demonstrated a slower onset and longer duration of motor and sensory block—an important consideration for timing early physiotherapy and monitoring—but the modest, time-limited analgesic advantage alone does not mandate choosing one technique over the other.

Hemodynamic outcomes offer the clearest practical distinction. The trial reported lower rates of hemodynamic instability with peripheral nerve blocks (16.7% vs 43.4%) and fewer bradycardia episodes (10% vs 33.3%). Most transient hypotensive events responded to crystalloid boluses without escalation to vasopressors. As a result, peripheral nerve blocks were associated with fewer intraoperative cardiovascular perturbations and a reduced need for pharmacologic intervention.

Although spinal anesthesia enabled faster early mobilization, the peripheral nerve block group experienced slower initial mobilization but a shorter overall hospital stay—findings that affect discharge planning and resource allocation.