General laryngeal mask airway anesthesia with lumbar plexus and sciatic block provides better outcomes than general anesthesia and endotracheal intubation in elderly patients undergoing hip surgery

Objective: To compare the perioperative outcomes and hemodynamic effects at induction of general laryngeal mask airway (LMA) anesthesia with lumbar plexus-sciatic nerve block (LPSB) and general anesthesia with endotracheal intubation (ET) in elderly patients undergoing hip surgery.

Methods: A total of 63 patients having open reduction internal fixation of an intertrochanteric fracture were randomly assigned to receive LMA anesthesia with LPSB or general anesthesia with ET. Perioperative and postoperative outcomes were compared between the 2 groups.

Results: Compared with the LMA/block group, there were significant reductions in systolic blood pressure, diastolic blood pressure, and mean arterial pressure at induction in the general endotracheal group (all, P < 0.001). In the general ET group, 84% of the patients experienced at least one episode of significant hypotension, whereas no patient in the LMA/block group had significant hypotension (P < 0.001). There were no changes in cardiac output, cardiac index, stroke volume, and stroke volume index of the LMA/block group, whereas significant changes were noted in the general anesthesia ET group. Significantly fewer complications were noted in the LMA/block group, and LMA block was associated with shorter weaning time, fewer returns to the intensive care unit, and less postoperative pain.

Conclusions: General LMA anesthesia with LPSB provides better outcomes that general ET anesthesia in elderly patients undergoing hip surgery.