Abstract
Background. An analgesic enhanced recovery (ER) protocol for patients with a hip fracture was introduced. It was hypothesised that the ER would reduce pain, length of stay and improve clinical outcomes. The protocol used intraoperative infiltration of levobupivacaine followed by ongoing wound infusions. Methods. Consecutive patients admitted to two hospitals were eligible for the ER protocol. Numerical Reporting Scale pain scores (0–10) were recorded alongside opiate requirements. 434 patients in the ER group (316 full ER, 90 partial ER, and 28 no ER) were compared to a control group (CG) of 100 consecutive patients managed with traditional opiate analgesia. Results. Mean opiate requirement was 49.2 mg (CG) versus 32.5 mg (ER). Pain scores were significantly reduced in the full ER group, p < 0.0001. Direct discharge home and mean acute inpatient stay were significantly reduced (p = 0.0031 and p < 0.0001, resp.). 30-day mortality was 15% (CG) versus 5.5% (ER), p = 0.0024. Conclusions. This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality.
Highlights
Enhanced recovery initiatives for orthopaedic surgery have been shown to improve patient outcomes and effectively reduce service demand and costs [1,2,3]
The aim of this study is to establish if local infiltration of anaesthetic (LIA) and indwelling anaesthetic catheter infusions (CATH) are superior to standard analgesia used in a control group (CG) for management of patients with a hip fracture
Length of stay decreased from 15 days (CG) to 10 days (ER); the proportion of patients being transferred to rehabilitation facilities increased, p < 0.0001
Summary
Enhanced recovery initiatives for orthopaedic surgery have been shown to improve patient outcomes and effectively reduce service demand and costs [1,2,3]. Evidence from LIA and CATH for knee arthroplasty surgery demonstrates lower opiate requirements and overall pain scores when compared to intrathecal morphine [10]. LIA and CATH in conjunction with other pharmacological, procedural, and behavioral adaptations for an enhanced recovery protocol for knee arthroplasty demonstrated an increased patient satisfaction, reduced blood transfusions, reduced length of stay, and decreased mortality [3]. This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality
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