title: The Challenges of Anaesthesia and Pain Relief in Hip Fracture Care.
abstract: The care of the older person with hip fracture is complicated by their comorbid condition, limited physiological reserve, cognitive impairment and frailty. Two aspects of hip fracture management that have received considerable attention are how best to manage the pain associated with it and the ideal mode of anaesthesia. Existing literature has reported on the suboptimal treatment of pain in this orthogeriatric cohort. With recent advancements in medical care, a number of options have emerged as alternatives to conservative systemic analgesia. Systemic analgesia, such as opioids, can lead to untoward side effects, especially in this particular group of patients. Hence, peripheral nerve blocks, epidural analgesia and regional anaesthesia have emerged as options in the delivery of adequate pain relief in hip fractures. Besides that, there is ongoing debate regarding the appropriate anaesthesia technique for surgical repair of the fractured hip. The benefits and risks related to either spinal anaesthesia or general anaesthesia have been subject to studies determining which method is associated with better short- and long-term outcomes. In this review, we aim to examine the evidence behind the different analgesia options available, compare spinal and general anaesthesia, and discuss the importance of the multidisciplinary orthogeriatric model of care in hip fracture and its potential role in other fragility fractures.
authors.affiliation: Department for Healthcare of Older People, Queens Medical Centre, HCOP Research Office, Nottingham University Hospitals NHS Trust, F Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Rachel
authors.initials: R
authors.lastname: Cowan
authors.affiliation: Department for Healthcare of Older People, Queens Medical Centre, HCOP Research Office, Nottingham University Hospitals NHS Trust, F Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Jun Hao
authors.initials: JH
authors.lastname: Lim
authors.affiliation: Department for Healthcare of Older People, Queens Medical Centre, HCOP Research Office, Nottingham University Hospitals NHS Trust, F Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK. terenceong@doctors.org.uk.|School of Medicine, University of Nottingham, Medical School, Nottingham, UK. terenceong@doctors.org.uk.
authors.forename: Terence
authors.initials: T
authors.lastname: Ong
authors.affiliation: School of Medicine, University of Nottingham, Medical School, Nottingham, UK.
authors.forename: Ashok
authors.initials: A
authors.lastname: Kumar
authors.affiliation: Department for Healthcare of Older People, Queens Medical Centre, HCOP Research Office, Nottingham University Hospitals NHS Trust, F Floor, West Block, Derby Road, Nottingham, NG7 2UH, UK.
authors.forename: Opinder
authors.initials: O
authors.lastname: Sahota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods*; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000627:therapeutic use; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D000765:Anesthesia, Conduction / Q000379:methods; D000768:Anesthesia, General / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods; D010146:Pain / Q000517:prevention & control*; D059408:Pain Management / Q000379:methods*
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid