Effect of Regional Anesthesia vs. General Anesthesia Technique on Perioperative Outcomes in Geriatric Patients With Hip Fracture: Narrative Review.

The rising incidence of hip fractures in aging populations necessitates optimized perioperative management to mitigate complications. This narrative review evaluates the impact of regional anesthesia (RA) and analgesia techniques compared to general anesthesia (GA) on perioperative outcomes in geriatric patients undergoing hip fracture surgery. Current evidence reveals no consistent mortality benefit for RA over GA. Multicenter trials such as REGAIN and RAGA found no significant difference in 30- to 60-day survival. Similarly, spinal anesthesia does not show a clear superior advantage over GA on postoperative delirium (POD) in geriatric hip fracture patients. For pneumonia and other major complications, current evidence remains inconclusive, with more well-designed studies needed in the future. Peripheral nerve blocks (PNBs), including femoral block, fascia iliaca compartment block, and pericapsular nerve group blocks, demonstrate superior perioperative analgesia by reducing opioid consumption and early pain scores. However, evidence on PNBs' effects on mortality or major complications remains limited. Overall, RA and GA exhibit comparable mortality outcomes, while PNBs enhance pain management but require further high-quality trials to assess long-term benefits. Current data highlight the need for individualized anesthesia strategies and robust RCTs to clarify optimal practices in high-risk geriatric populations.