White 1980.
| Methods | RCT "consent was sought for inclusion in the trial" |
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| Participants | Orthopaedic hospital in Cape Town, South Africa
40 of 60 patients in trial with a proximal femoral fracture of less than 8 days Operated at a mean of 3.5 days from the fracture Zimmer sliding screw (64%) or Moore prosthesis (36%) Mean age 79 years (> 60 years [range not stated]) Male: 8% Number lost to follow‐up: 0 |
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| Interventions | All patients received diazepam 10 mg orally 2 hours before surgery Treatment group 1: Spinal anaesthesia with 0.6‐0.8 mL hyperbaric cinchocaine and 'light' general anaesthesia with althesin, fentanyl, nitrous oxide/oxygen. Injection in the lateral decubitus position and maintained lying on the fractured side for 5 minutes (n = 20) Treatment group 2: Psoas nerve block with 30 mL 2% mepivacaine and 'light' general anaesthesia with fentanyl and althesin (n = 20 randomized; n = 16 analysed). Chayen's technique with the fracture side uppermost. This group was not retained (outside the scope of the present review) Control group: General anaesthesia with thiopentone, suxamethonium, nitrous oxide/oxygen, halothane, fentanyl. Competitive neuromuscular blocking drugs were not used.This group (n = 20) was split in two for comparison with the two treatment groups |
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| Outcomes | Mortality at 1 month
Length of surgery
Pneumonia
Acute confusional state
Deep vein thrombosis Total medical complications (pneumonia, deep vein thrombosis) |
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| Notes | Length of follow‐up: minimum 4 weeks presence/absence of thromboprophylaxis not mentioned |
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| Risk of bias | ||
| Bias | Authors' judgement | Support for judgement |
| Random sequence generation (selection bias) | Unclear risk | "randomly allocated", no details |
| Allocation concealment (selection bias) | Unclear risk | Not mentioned |
| Blinding of participants and personnel (performance bias) All outcomes | High risk | Not mentioned |
| Blinding of outcome assessment (detection bias) All outcomes | High risk | Not mentioned |
| Incomplete outcome data (attrition bias) All outcomes | Low risk | No loss to follow‐up |
| Selective reporting (reporting bias) | Low risk | No failed block mentioned |
| Other bias | Unclear risk | Groups well balanced except possibly for a lower number of preoperative pneumonia in the Psoas compartment block group |
Abbreviations AMT: Abbreviated mental test; ASA: American Society of Anesthesiologists (ASA) physical status; BIS: bispectral index monitor; b.p.m.: beats per minute; CHF: cardiac heart failure; CPNB: continuous peripheral nerve block; DVT: deep venous thrombosis; EKG: electrocardiogram; GA: general anaesthesia; h: hour; IM: intramuscular; IPPV: intermittent positive pressure ventilation; IV: intravenous; kg: kilogram; L: Lumbar; MAP: mean arterial blood pressure; mg: milligram; MI: myocardial infarction; mL: millilitres; mm HG: millimetre of mercury; MMSE: mini mental state examination; n: number; PE: pulmonary embolism; PNB:; peripheral nerve block; RCT: randomized controlled trial; SA: spinal anaesthesia; T: Thoracic; ug: microgram