Effect of postoperative epidural analgesia on rehabilitation and pain after hip fracture surgery: a randomized, double-blind, placebo-controlled trial.
BACKGROUND
Hip fracture surgery usually carries a high demand for rehabilitation and a significant risk of perioperative morbidity and mortality. Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures. No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery.


METHODS
Sixty elderly patients were included in a randomized, double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine, 0.125%, and 50 mug/ml morphine versus placebo. Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine. All patients followed a well-defined multimodal rehabilitation program. Pain, ability to participate in four basic physical functions, and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy.


RESULTS
Epidural analgesia provided superior dynamic analgesia during all basic physical functions, and patients were significantly less restricted by pain, which was the dominating restricting factor in the placebo group. Motor blockade was not a restricting factor during epidural analgesia. Despite improved pain relief, scores for recovery of physical independence were not different between groups.


CONCLUSIONS
Postoperative epidural analgesia after hip fracture surgery provides superior analgesia attenuating pain as a restricting factor during rehabilitation without motor dysfunction. However, superior analgesia did not translate into enhanced rehabilitation. Future studies with multimodal rehabilitation are required to establish whether superior analgesia can be translated into enhanced rehabilitation and reduced morbidity in hip fracture patients.
Foss
Nicolai Bang
NB
Departments of Anaesthesiology and Orthopaedic Surgery, Hvidovre University Hospital, DK-2650 Copenhagen, Denmark. nicolai.bang.foss@hh.hosp.dk
Kristensen
Morten Tange
MT
Kristensen
Billy Bjarne
BB
Jensen
Pia Søe
PS
Kehlet
Henrik
H
D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural / Q000379:methods*; D004311:Double-Blind Method; D005260:Female; D006620:Hip Fractures / Q000534:rehabilitation* / Q000601:surgery*; D006801:Humans; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy* / Q000503:physiopathology; D011182:Postoperative Care / Q000379:methods*; D020127:Recovery of Function / Q000187:drug effects / Q000502:physiology