Efficacy of Regional Anesthesia in Reducing Perioperative Pain and Delirium in Elderly Patients Undergoing Hip Fracture Surgery: An Umbrella Review.

The incidence of hip fractures is a significant health concern, especially among the elderly, who are an important population to consider while doing anesthesia. Although clinical guidelines support regional anesthesia (RA) for pain management, its consistent use in hip fracture surgery remains limited. This umbrella review evaluates the efficacy of RA in reducing perioperative pain and the incidence of delirium in hip fracture patients. A comprehensive search was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines across five databases (PubMed, PubMed Central, Google Scholar, ScienceDirect, and Cochrane Library) for studies published between January 1, 2015, and January 1, 2025. Of 1727 articles identified, a total of 16 systematic reviews and/or meta-analyses met the inclusion criteria after rigorous screening with the help of Microsoft Excel (Microsoft® Corp., Redmond, WA, USA) and a quality assessment according to the AMSTAR (A MeaSurement Tool to Assess Systematic Reviews) score system. Findings indicate that RA, particularly spinal anesthesia combined with femoral and fascia iliaca compartment blocks (FICBs), offers significant benefits over general anesthesia, including reduced opioid use, lower pain scores, and decreased risk of postoperative delirium. These results support RA as a preferred approach for improved outcomes, such as shorter hospital stays and enhanced postoperative recovery in geriatric patients.