Hip fracture surgery is common and the population at risk is generally elderly. There is no consensus of opinion regarding the safest form of anaesthesia for these patients. We performed a meta-analysis of 15 randomized trials that compare morbidity and mortality associated with general or regional anaesthesia for hip fracture patients. There was a reduced 1-month mortality and incidence of deep vein thrombosis in the regional anaesthesia group. Operations performed under general anaesthesia had a reduction in operation time. No other outcome measures reached a statistically significant difference. There was a tendency towards a lower incidence of myocardial infarction, confusion and postoperative hypoxia in the regional anaesthetic group, and cerebrovascular accident and intra-operative hypotension in the general anaesthetic group. We conclude that there are marginal advantages for regional anaesthesia compared to general anaesthesia for hip fracture patients in terms of early mortality and risk of deep vein thrombosis.

Nefopam is a non-opioid analgesic agent with a central mode of action involving activation of descending pain-modulating pathways and inhibition of synaptosomal uptake of hydroxytryptamine, norepinephrine and dopamine. Adverse effects during therapeutic use and after overdose of nefopam are known to involve the central nervous system (confusion and convulsions), the cardiovascular system (tachycardia and palpitations) and the kidneys (oliguria and renal failure). We report a death after nefopam overdose in a young woman who exhibited many of these features. It is only the second case of death after nefopam overdose in the literature.

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