{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T17:43:53Z","timestamp":1789753433856,"version":"4.0.1"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T00:00:00Z","timestamp":1773014400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Positioning for neuraxial anesthesia in geriatric lower extremity fracture surgery is painful and can destabilize hemodynamics. Sedation\u2013analgesia must balance effective analgesia with respiratory safety and physiologic stability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This single-center retrospective cohort study included patients aged \u226565\u202fyears undergoing lower extremity fracture surgery under spinal anesthesia who received S-ketamine plus dexmedetomidine (Group A,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f48) or S-ketamine plus propofol (Group B,\n                      <jats:italic>n<\/jats:italic>\n                      \u202f=\u202f46). Primary outcomes included a numerical rating scale (NRS) positioning pain score of 0\u201310 and an ordinal posture quality score measured at five stages (T1\u2013T5). Repeated measures were analyzed using mixed-effects models (group, stage, group\u00d7stage; random: patient) with covariate adjustment. Stage-wise contrasts were Holm-corrected.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 100 records were screened, and 94 patients were analyzed. Group\u00d7stage interactions were significant for pain and posture quality. Group A had lower pain during the most noxious stages (T3\u2013T5; adjusted differences \u22120.42 to \u22120.50) and higher odds of better posture quality (OR 2.30\u20132.70). Physiological differences were modest and stage-specific, with slightly higher SpO\n                      <jats:sub>2<\/jats:sub>\n                      and lower heart rate (HR)\/mean arterial pressure (MAP) at T2\u2013T3. Postoperative NRS differed only at 12\u202fh. Adverse events were infrequent; delirium was identified from routine documentation without a standardized instrument (0\/48 vs. 2\/46).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In this retrospective cohort, dexmedetomidine-based sedation with S-ketamine was associated with improved comfort and cooperation during spinal positioning compared with propofol-based sedation, while adverse events were infrequent in both groups.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1706118","type":"journal-article","created":{"date-parts":[[2026,3,9]],"date-time":"2026-03-09T05:30:17Z","timestamp":1773034217000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["S-ketamine plus dexmedetomidine vs. S-ketamine plus propofol for sedation\u2013analgesia during positioning for spinal anesthesia in older adults undergoing lower extremity fracture surgery"],"prefix":"10.3389","volume":"17","author":[{"given":"Yingying","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Beiiing Electric Power Hospital of State Grid Corporation of China","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tianjiao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beiiing Electric Power Hospital of State Grid Corporation of China","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wenyong","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Beiiing Electric Power Hospital of State Grid Corporation of China","place":["Beijing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,3,9]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"e1291","DOI":"10.5435\/JAAOS-D-22-00125","article-title":"AAOS clinical practice guideline summary: Management of hip Fractures in older adults","volume":"30","author":"O'Connor","year":"2022","journal-title":"J Am Acad Orthop Surg"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1002\/jbmr.4821","article-title":"Global epidemiology of hip fractures: secular trends in incidence rate, post-fracture treatment, and all-cause mortality","volume":"38","author":"Sing","year":"2023","journal-title":"J Bone Miner Res Off J Am Soc Bone Miner Res"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"1039","DOI":"10.7326\/M22-1391","article-title":"Severe pain after hip fracture repair in older adults: challenging a dominant 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