{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T12:25:59Z","timestamp":1791203159605,"version":"4.2.0"},"reference-count":15,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T00:00:00Z","timestamp":1778803200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Anesthetizing frail patients for hip surgery is challenging; spinal (SA) and general anesthesia (GA) often cause hemodynamic instability. Traditional nerve blocks provide analgesia but rarely complete surgical anesthesia without motor block. We evaluate the clinical feasibility of the SAFE (Subarachnoid-alternative Anaesthesia For Endoprosthesis) protocol\u2014combining Anterior Pericapsular Nerve Group (A-PENG), POsterior pericapsular Nerve Group (PONG), and Local Infiltration Analgesia (LIA) under intravenous sedation\u2014as a primary anesthetic preserving motor function and avoiding SA\/GA. Methods: This single-center retrospective series analyzed patients undergoing elective or trauma-related hip surgery using the SAFE protocol between September 2022 and April 2026. The primary outcome was success rate (completion without SA\/GA conversion). Secondary outcomes included procedural timings, recovery room (RR) transit, and motor preservation. Variables are reported as medians [IQR]. Results: We included 48 patients (median age 83.5 years [IQR: 68.7\u201387.2]; 66.7% female) undergoing hip hemiarthroplasty (n = 28) or total hip arthroplasty (n = 20). The success rate was 100%, without SA\/GA conversion or advanced airway management. Median anesthetic preparation and surgical durations were 55 [IQR: 50\u201376.2] and 85 min [IQR: 74\u2013110], respectively. RR transit times (recorded for 35 patients) were brief (40 min [IQR: 34.0\u201367.5]). Crucially, lower-limb motor capacity was preserved in 100% of cases. The technique also proved opioid-sparing, substantially reducing postoperative opioid consumption. Conclusions: The SAFE protocol is a clinically feasible primary anesthetic strategy for hip surgery. By preserving motor function and enabling rapid fast-tracking, it aligns with ERAS pathways, offering a promising alternative to conventional anesthesia for elective and frail trauma patients. Randomized controlled trials are warranted to validate these outcomes.<\/jats:p>","DOI":"10.3390\/jcm15103808","type":"journal-article","created":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T10:33:21Z","timestamp":1778841201000},"page":"3808","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["SAFE (Subarachnoid-Alternative Anaesthesia for Endoprosthesis): A Motor-Sparing and Opioid-Sparing Anesthetic Technique for Hip Fracture Surgery"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5240-6131","authenticated-orcid":false,"given":"Romualdo","family":"Del Buono","sequence":"first","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raffaella","family":"Barretta","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paola","family":"Marsico","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, Valle d\u2019Itria Hospital, 74015 Martina Franca, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chiara","family":"Palermo","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2519-9904","authenticated-orcid":false,"given":"Fabio","family":"Costa","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5076-3693","authenticated-orcid":false,"given":"Giuseppe","family":"Pascarella","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, Fondazione Policlinico Universitario Campus Bio-Medico, 00128 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1715-0991","authenticated-orcid":false,"given":"Giorgio","family":"Ranieri","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, Isola Tiberina Hospital\u2014Gemelli Isola, 00186 Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Togn\u00f9","sequence":"additional","affiliation":[{"name":"Anesthesiology and Intensive Care Unit, ASST Gaetano Pini-CTO, 20122 Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"698","DOI":"10.1016\/S0140-6736(20)30058-1","article-title":"Accelerated Surgery versus Standard Care in Hip Fracture (HIP ATTACK): An International, Randomised, Controlled Trial","volume":"395","author":"Borges","year":"2020","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1111\/anae.15291","article-title":"Guideline for the Management of Hip Fractures 2020: Guideline by the Association of Anaesthetists","volume":"76","author":"Griffiths","year":"2021","journal-title":"Anaesthesia"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1336","DOI":"10.1097\/ALN.0000000000000478","article-title":"Perioperative Management of Elderly Patients with Hip Fracture","volume":"121","author":"Boddaert","year":"2014","journal-title":"Anesthesiology"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.3310\/MDTT6530","article-title":"Enhanced Recovery Pathway for Older People with Hip Fracture and Cognitive Impairment in Acute Hospitals: The PERFECTED Research Programme Including an RCT","volume":"13","author":"Fox","year":"2025","journal-title":"Programme Grants Appl. Res."},{"key":"ref_5","first-page":"1021","article-title":"Hemodynamic Changes Associated with Spinal and General Anesthesia for Hip Fracture Surgery in Severe ASA III Elderly Population: A Pilot Trial","volume":"79","author":"Messina","year":"2013","journal-title":"Minerva Anestesiol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Zheng, X., Tan, Y., Gao, Y., and Liu, Z. (2020). Comparative Efficacy of Neuraxial and General Anesthesia for Hip Fracture Surgery: A Meta-Analysis of Randomized Clinical Trials. BMC Anesthesiol., 20.","DOI":"10.1186\/s12871-020-01074-y"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"6896066","DOI":"10.1155\/2024\/6896066","article-title":"Efficacy and Safety of Pericapsular Nerve Group Block for Hip Fracture Surgery under Spinal Anesthesia: A Meta-Analysis","volume":"2024","author":"Li","year":"2024","journal-title":"Int. J. Clin. Pract."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1065","DOI":"10.1302\/2633-1462.69.BJO-2025-0046.R1","article-title":"Enhanced Recovery Following Neck of Femur Fractures\u2014Improving Outcomes","volume":"6","author":"See","year":"2025","journal-title":"Bone Jt. Open"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"103135","DOI":"10.1016\/j.otsr.2021.103135","article-title":"Comparison of Pericapsular Nerve Group (PENG) Block with Fascia Iliaca Compartment Block (FICB) for Pain Control in Hip Fractures: A Double-Blind Prospective Randomized Controlled Clinical Trial","volume":"108","author":"Mosaffa","year":"2022","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_10","first-page":"859","article-title":"Pericapsular Nerve Group (PENG) Block for Hip Fracture","volume":"43","author":"Peng","year":"2018","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_11","first-page":"1157","article-title":"PENG Block: From Standard to Unconventional Approaches","volume":"87","author":"Pascarella","year":"2021","journal-title":"Minerva Anestesiol."},{"key":"ref_12","first-page":"1242","article-title":"Ultrasound-Guided Local Infiltration Analgesia for Hip Surgery: Myth or Reality?","volume":"85","author":"Pascarella","year":"2019","journal-title":"Minerva Anestesiol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"54","DOI":"10.1007\/s10916-025-02187-y","article-title":"Target-Controlled Infusion of Propofol: A Systematic Review of Recent Results","volume":"49","author":"Bruthans","year":"2025","journal-title":"J. Med. Syst."},{"key":"ref_14","first-page":"458","article-title":"Pericapsular Nerve Group Block: An Overview","volume":"87","author":"Padua","year":"2021","journal-title":"Minerva Anestesiol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"100127","DOI":"10.1016\/j.bjao.2023.100127","article-title":"Deep Posterior Gluteal Compartment Block for Regional Anaesthesia of the Posterior Hip: A Proof-of-Concept Pilot Study","volume":"5","author":"Vermeylen","year":"2023","journal-title":"BJA Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3808\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,15]],"date-time":"2026-05-15T11:06:48Z","timestamp":1778843208000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/10\/3808"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,15]]},"references-count":15,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2026,5]]}},"alternative-id":["jcm15103808"],"URL":"https:\/\/doi.org\/10.3390\/jcm15103808","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,15]]}}}