The purpose of this study is to look at how two different types of anesthesia, spinal and general, affect participants with broken hips who are getting a special kind of pain block before surgery. Researchers will check: * How quickly patients are ready for anesthesia * How long they stay in the recovery room after surgery * How much pain medicine they need during recovery * If they experience any confusion * If one group has complications in one of these anesthesia techniques? Participants in the study will be put into one of two groups by chance to see if there's a difference in their recovery.
This clinical trial aims to compare two common anesthesia techniques, spinal and general anesthesia, combined with a preoperative nerve block called the Fascia Iliaca Compartment Block (FICB). The objective is to understand how these methods affect patients undergoing hip fracture surgery. The main questions this study aims to answer are: * Does the choice between spinal and general anesthesia influence how quickly patients recover from anesthesia? * Does it affect how long patients stay in the Post-Anesthesia Care Unit (PACU)? * Does it change the amount of opioid pain medication needed after surgery? * Do the different anesthesia types impact the occurrence of postoperative delirium? * Do they affect the length of the hospital stay after surgery? * Do they lead to different rates of post-operative complications? Participants will: * Receive either spinal anesthesia with Fascia Iliaca Compartment Block (FICB) (Arm A) or general anesthesia with Fascia Iliaca Compartment Block (FICB) (Arm B). * Undergo an ultrasound-guided FICB injection. * Receive appropriate anesthesia and sedation during surgery. * Be monitored for pain and provided with pain relief as needed. The study's broader objectives include enhancing patient safety and satisfaction, reducing hospital readmission rates, lowering healthcare costs, and improving overall healthcare practices. Although direct benefits to participants are not guaranteed, the findings will inform better care for future patients with hip fractures.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
Participants in this arm will receive single-shot spinal anesthesia with 12-15 mg of either 0.05% or 0.75% bupivacaine (iso or hyperbaric) once before surgery. Additionally, they will undergo an ultrasound-guided nerve block called the Fascia Iliaca Compartment Block (FICB ) in combination with spinal anesthesia.
Participants in this group will be given a combination of general anesthesia and a nerve block. General anesthesia involves the use of a sedative called propofol, along with devices to ensure that the airway remains open during the procedure. Additionally, they will undergo an ultrasound-guided nerve block known as the Fascia Iliaca Compartment Block (FICB) in combination with spinal anesthesia.
Measuring Pain: Visual Analog Scale (VAS)
The pain scale ranges from 0, no pain, to 10, the worst pain imaginable.
Time frame: Postoperative Anesthesia Unit (PACU) stay: Approximately 2-4 hours from arrival to PACU to release to the floor.
Post-anesthesia Care Unit (PACU) Opioid consumption
Post-anesthesia opioid use is measured in milligrams (Morphine Equivalent table) and tracked in the PACU to manage pain. Lower use suggests reasonable pain control; higher use indicates more pain and inadequate control.
Time frame: Approximately 2-4 hours: From the moment the patient arrives in the Post Anesthesia Care Unit (PACU) until their departure to the floor..
Post-Anesthesia Care Unit Stay
The Aldrete Score, used in the PACU, rates from 0 to 10 for discharge readiness. Higher scores mean patients' vital signs are stable; lower scores require more recovery time.
Time frame: Approximately 2-4 hours: From the moment the patient arrives in the Post Anesthesia Care Unit (PACU) until their departure to the floor..
Postoperative complications:
We are monitoring post-op complications like episodes of postoperative nausea and vomiting (PONV) with the "PONV impact Scale" in the postoperative care unit, the presence of infections, thrombosis (DVT), and pulmonary and heart issues. PONV will be assessed in PACU; a score ≥5 on the PONV Scale is significant.
Time frame: Monitoring for PONV, DVT, and cardiac/pulmonary issues occurs at 24, 48, and 72 hours post-admission for observation.
Post-Surgery Hospital Stay
The period between the end of the surgical procedure and hospital discharge.
Time frame: Post-surgery stay is hospital typically 7-10 days for recovery and complication management. Extended stays may signal recovery delays.
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SINGLE
Enrollment
102
Cognitive impairment and delirium
The Mini-Cognitive Assessment Instrument (Mini-Cog) Test is a quick screening tool used to identify possible cases of cognitive impairment. It combines a three-item memory test and a clock-drawing task and is typically used in settings where time is a constraint. If a score below three is obtained, it raises concerns about dementia.
Time frame: We measure at two point 1) Pre-operative 2) on post operative day one