15.5Review protocol - Anaesthesia

Review questionIn patients undergoing surgical repair for hip fractures, what is the clinical and cost effectiveness of regional (spinal/epidural) anaesthesia compared to general anaesthesia in reducing complications such as mortality, cognitive dysfunction thromboembolic events, postoperative respiratory morbidity, renal failure and length of stay in hospital?
ObjectivesTo identify whether regional anaesthesia confers any benefit compared to general anaesthesia with regards to reducing complications and improving patient outcomes after surgery.
PopulationPatients over 18 years old with a hip fracture undergoing different types of surgery for hip fracture repair

People with fractures caused by specific pathologies other than osteoporosis or osteopaenia, and patients under 18 years old are excluded from the scope.
InterventionGeneral anaesthesia for different types of surgery
  • Regional anaesthesia for the same type of surgery

    Spinal/epidural without nerve block

    Spinal/epidural with nerve block


Patient preference

Mortality at 30 days

Functional status up to 1 year

Pain (generally measured by visual analogue scale or verbal rating)

Adverse effects

Search strategyThe databases to be searched are Medline, Embase, The Cochrane Library, CINAHL and AMED.

Randomised controlled trials (RCTs) will be considered. If no RCTs are found for certain outcomes such as adverse events, well conducted cohort studies and observational studies may also be considered.

Studies will be restricted to English language only

No date restriction will be applied. Databases will be searched from their date of origin
The review strategyMeta-analyses will be conducted where possible.

If there is heterogeneity the following subgroups will be analysed separately (where possible):

Comorbidities strongly predictive of outcome

Concurrent medication



Cognitive impairment

Type of surgery

  • THR vs. hemiarthroplasty
  • THR vs. internal fixation

Duration of anaesthesia

From: Appendix C, Review protocols

Cover of The Management of Hip Fracture in Adults
The Management of Hip Fracture in Adults [Internet].
NICE Clinical Guidelines, No. 124.
National Clinical Guideline Centre (UK).
Copyright © 2011, National Clinical Guideline Centre.

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