Neuraxial vs. General Anesthesia for Hip Fracture Repair

September 14, 2020
Image of X-ray showing hip

Though hip fracture repair has become a standard orthopedic procedure, the debate over the ideal method of anesthesia persists. Research suggests that the use of general or neuraxial anesthesia for surgery should be determined on a case-by-case basis.

Both general and neuraxial anesthesia are commonly used for surgical hip fracture repair. Neuraxial anesthesia is an umbrella term for the administration of either opioids or local anesthesia to induce analgesia in the region below the umbilicus, including the lower extremities.[1] Anesthetics may be injected into the fatty tissue surrounding the nerve fibers or into the cerebrospinal fluid via a small needle. Auxiliary agents lessen the quantity of local anesthetic required for analgesia, but have no other significant advantages.[2] Neuraxial anesthesia is occasionally preferred over general anesthesia, which is administered systemically, therefore increasing the risk of adverse symptoms.

Research seeking to establish the superior anesthetic option has been inconsistent. Studies have suggested that neuraxial anesthesia can decrease blood loss [3] as well as reduce risk of postoperative nausea and deep venous thrombosis;[4],[5] however, other studies have reported that general anesthesia induces a more stable hemodynamic state and lessens risk of complications like infection.[6],[7] Zheng et al. performed a meta-analysis of randomized clinical trials and found that mortality rates during the first month of recovery did not differ significantly between patients who underwent neuraxial versus general anesthesia for hip fracture repair. Similarly, length of stay, presence of delirium, and instances of post-operative deep venous thrombosis and pneumonia did not differ significantly between patient groups.[8] The authors did find significantly decreased blood loss in the patients that underwent neuraxial anesthesia before applying the Bonferroni correction for multiple testing; however, they further reported a lack of robust data to support this trend.

The lack of significantly different outcomes for hip repair patients who have undergone either neuraxial or general anesthesia suggests that the superior option may differ by patient, and that anesthesiologists should consider individual requirements, comorbidities, and possible complications when making pre-surgical determinations.


[1] Miller’s Anesthesia (8 ed.). Elsevier. 2015. pp. 1684–1720.

[2] Aveline, Christophe, MD; El Metaoua, Sonia, MD; Masmoudi, Anis, MD; Boelle, Pierre-Yves, PhD; Bonnet, Francis, MD. The Effect of Clonidine on the Minimum Local Analgesic Concentration of Epidural Ropivacaine During Labor, Anesthesia & Analgesia. 2002;735-740. doi:10.1213/00000539-200209000-0003.

[3] White SM. Foss NB.Anesthesia aspects in the treatment of fragility fracture patients. Injury. 2018;49:1403–8.

[4] Radić N, Radinović K, Ille M, et al. The selection of best anesthesiological technique for hip fracture surgery in older high-risk patients. Acta Chir Iugosl. 2012;59:113–5.

[5] Kowark A, Rossaint R. General versus spinal anesthesia for the elderly hip fractured patient. Curr Opin Anaesthesiol. 2019;32:116–9.

[6] Rivas E. Geriatric patients undergoing non-elective surgery for hip fracture: can management be optimized? J Clin Anesth. 2019;59:112–3.

[7] Zheng H, Wang Y, Wang Y. Comparison of the effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty. Exp Ther Med. 2019;17:4421–6.

[8] Zheng, X., Tan, Y., Gao, Y. et al. Comparative efficacy of Neuraxial and general anesthesia for hip fracture surgery: a meta-analysis of randomized clinical trials. BMC Anesthesiol. 2002.