Pre‐operative epidural analgesia in hip fracture patients ‐ A systematic review and meta‐analysis

Rubin, Monika Afzali; Stark, Nikolaj Francis; Hårsmar, Simon Julius Chamli; Møller, Ann Merete

doi:10.1111/aas.13760

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…Therefore, the authors of the trial do not recommend the use epidural analgesia in this setting due to frequent technical problems 20 . A systematic review by Rubin et al analyzed three randomized controlled trials studying pre-operative epidural analgesia in hip fracture patients and did not find a difference between epidural analgesia and systemic therapy 62 .…”

Section: Epidural Anesthesia and Analgesiamentioning

confidence: 99%

Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Pissens,

Cavens,

Joshi

et al. 2024

Acta Anaest Belg

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Hip fracture is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and length of stay. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after hip fracture. A systematic review utilising procedure specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials, systematic reviews and meta-analysis published in the English language between 04 April 2005 and 12 May 2021, evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane Databases. A total of 60 studies met the inclusion criteria. For patients having hip fracture, pre, intra and postoperative paracetamol and non-steroidal anti-inflammatory drugs or COX-2 inhibitors are recommended. A single shot femoral nerve block or a single shot fascia iliaca compartment block are recommended. Continuous catheter techniques should be used only in specific circumstances. The choice between femoral nerve block or a fascia iliaca compartment block should be made according to local expertise. The postoperative regimen should include regular paracetamol, non-steroidal anti-inflammatory drugs and COX-2 inhibitors with opioids used for rescue. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations, while other interventions were not recommended due to insufficient, inconsistent or lack of evidence.

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Section: Epidural Anesthesia and Analgesiamentioning

confidence: 99%

Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Pissens,

Cavens,

Joshi

et al. 2024

Acta Anaest Belg

View full text Add to dashboard Cite

show abstract

“…After a systematic review and meta-analysis, investigators report no difference in preoperative pain at rest between epidural analgesia and any other method of preoperatively initiated analgesia in hip fracture patients. (See Rubin et al, 2020. )…”

mentioning

confidence: 99%

Preoperative Epidural Analgesics in Patients With Hip Fracture

2021

Lippincott's Bone and Joint Newsletter

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Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

Strange,

Nielsen,

Nielsen

et al. 2024

International Journal of Surgery Open

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Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March–May and September–November 2022) at Gødstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.

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Pre‐operative epidural analgesia in hip fracture patients ‐ A systematic review and meta‐analysis

Cited by 3 publications

References 37 publications

Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Preoperative Epidural Analgesics in Patients With Hip Fracture

Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

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