Issn Print: 0265-0215

Publication Date: 2007/06/01


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A national survey: peri-operative anaesthetic management of patients with femoral neck fractures in the UK: 8AP9-1

M. Sandby-Thomas; G. Sullivan; J. Hall

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Background and Goal of Study: Surgical correction of a fractured neck of femur is an extremely common orthopaedic procedure. The incidence of hip fractures worldwide is predicted 4.5 million by 2050 with some estimates putting the figure as high as 21.3 million (1). The standardised mortality ratio is much higher in these patients than in the general population of comparable age (2). There are various options for the anaesthetic management of these but no one anaesthetic technique has been shown to be clearly superior to any other (3). Our survey gives a national snapshot of current anaesthetic practice in the UK which will enable us to focus and direct further research into this important area.
Materials and Methods: We randomly selected 20% of acute hospitals in the UK and sent postal tick-box questionnaires to the trauma anaesthetists working there with stamp addressed envelopes for replies. The questions pertained to peri-operative aspects of anaesthetic care.
Results and Discussions: We received 155 replies from 218 questionnaires sent (71.1% response rate). Regional anaesthesia (RA) was preferred by 75.8% of respondents, 14.4% combined general anaesthesia (GA) with a regional technique and 9.8% used GA alone. A spinal was the preferred RA in 95.5% of cases. This was generally performed bad side down (45.7%) using ketamine (37.3%) and/or midazolam (41.2%) to aid positioning. When GA was employed, either alone or in combination, respondents used a laryngeal mask airway (71.3%) with the patient breathing spontaneously (56.2%) on volatile agents (84.3%). If GA and RA were used together, a 3-in-1 block was the most popular adjunct (47.1%). Paracetamol and morphine were the most common post-operative analgesic regimes with continuous epidural or nerve block infusions used rarely.
Conclusion(s): Spinal Anaesthesia is the most commonly employed anaesthetic technique for hip fracture in the UK despite clear evidence of its benefits.
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