title: Local Anaesthetic Infiltration and Indwelling Postoperative Wound Catheters for Patients with Hip Fracture Reduce Death Rates and Length of Stay.
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.
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: William D
authors.initials: WD
authors.lastname: Harrison
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Deborah
authors.initials: D
authors.lastname: Lees
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Jamie
authors.initials: J
authors.lastname: A'Court
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Ankers
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Ian
authors.initials: I
authors.lastname: Harper
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Dominic
authors.initials: D
authors.lastname: Inman
authors.affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.
authors.forename: Mike R
authors.initials: MR
authors.lastname: Reed