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Background and Aims Hip fractures are the commonest reason for older patients presenting for emergency surgery (1) and are extremely painful (2). National guidelines recommend routine performance of supplementary nerve blocks alongside general/spinal anaesthesia (GA/SA respectively) (3). We aimed to evaluate departmental practice and identify areas for improvement.
Methods A retrospective audit was undertaken following local audit committee approval. Data were obtained from the National Hip Fracture Database (NHFD) spanning one year (Jan-Dec 2022), patients who underwent surgical intervention were included. Electronic records were analysed for: anaesthesia type; intra-operative nerve block performance; and block conduct.
Results 158 cases were identified. 64% received a block alongside GA/SA, majority were fascia iliaca blocks (85%). Others included femoral/lateral femoral cutaneous nerve of the thigh blocks. 89% were performed under ultrasound guidance, and most anaesthetists utilised bupivacaine as a sole agent. Block rates did not vary significantly between weekdays/weekends nor months of the year. Few documented reasons for not administering a block, these included: patient refusal, delirium, and anticoagulation.
Conclusions Compared to 2021 national data (4), our institution has a higher rate of intra-operative block performance for patients receiving SA (70% versus 44%), being similar for GA (55% versus 58%), potentially due to block analgesia facilitating SA positioning. Anticoagulation does not preclude performing superficial blocks (5), however the true extent of this being erroneously regarded as a contraindication is unknown due to lack of documentation. There is a role for surveying departmental attitudes and knowledge towards block performance, and providing teaching sessions involving contemporary technology such as needling simulators.
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