Background and Aims Regional anaesthesia makes a substantial contribution to the care of patients undergoing surgical fixation of neck of femur (NOF) fractures, a group at significantly increased risk of perioperative complications due to their frailty and comorbidities. We reviewed current management at our district general hospital, comparing it to the latest Association of Anaesthetists’ guidelines (2020).
Methods Pre-, intra- and post-operative data points were collected prospectively on patients undergoing NOF fixation over a 10-week period.
Results 101 patients were included. The study group was found to be elderly (mean age 81y), comorbid (ASA III: 59.6%, ASA IV: 22.0%) and frail (Clinical Frailty Scale ≥4: 80.2%). Peripheral nerve blocks (PNB) were performed in 78.2% of cases and showed wide variation in technique (see table 1). 21.8% of patients did not receive a PNB, 90.9% of whom received a spinal anaesthetic. Regarding spinal anaesthesia, hyperbaric 0.5% bupivacaine was used in 84.6% of cases and isobaric 0.5% bupivacaine in 15.4%, whilst local anaesthetic volume ranged from 1.8 – 2.6 ml. Neuraxial opiates were used in 61.5%.
Conclusions The Association of Anaesthetists recommend all patients receive a PNB. This target was not met, primarily in those receiving neuraxial anaesthesia. In some PNBs, local anaesthetic volume may have been subtherapeutic. Opiate use in neuraxial blocks is no longer recommended and a maximum dose <2 ml 0.5% bupivacaine advised to minimise adverse effects. These discrepancies between current practice and latest evidence were presented and our local guidelines are now under review. Further education and training in regional anaesthesia will be undertaken.
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