Comparison of Peripheral Nerve Blocks and Spinal Anaesthesia for Proximal Femoral Nailing - A Randomized Controlled Study

Introduction: Hip fractures due to osteoporosis are a major source of morbidity in the elderly. Proximal femoral nailing (PFN) is the preferred treatment for unstable intertrochanteric and subtrochanteric fractures. Spinal anesthesia (SA) is the most common regional technique, but Combined Peripheral Nerve Blocks (CPNB) are increasingly used. Evidence comparing these modalities remains limited. Objectives: To compare the need for rescue analgesia after CPNB and SA for PFN surgery. To evaluate postoperative recovery quality at 24 hours, ICU admission, and hospital stay. Methods: A randomized controlled trial was conducted on 60 patients undergoing PFN. Participants were allocated to receive either CPNB (Group A) or SA (Group B). All patients followed a standardized postoperative analgesic protocol. Time to first rescue analgesia, total rescue dose within 24 hours, quality of recovery at 24 hours, ICU admission, and hospital stay were recorded. Data were analyzed using Student?s t-test and Chi-square test. Results: Mean postoperative analgesia lasted 5.5 hours with CPNB and 3.5 hours with SA, though the difference in time to rescue analgesia was not statistically significant. Hemodynamics were more stable in the CPNB group, with hypotension in 15.8% versus 53.8% in the SA group. ICU admission rates were similar between groups, but hospital stay was shorter with CPNB. Conclusion: CPNB provides more stable perioperative hemodynamics and reduces hospital stay compared to SA, though postoperative analgesia duration and ICU needs were not significantly different.