Enhanced Recovery for Fractured Neck of Femur

Abstract

Enhanced recovery is now a standard model of care in most UK elective surgical units. For hip and knee arthroplasty this approach typically includes opioid-sparing anesthesia (OSA), local infiltration analgesia (LIA), and day of surgery mobilization. There is evidence that these interventions shorten hospital stay and improve outcomes, without increasing complications or readmissions. These interventions may also benefit patients undergoing surgery for femoral neck (hip) fractures. This group of patients are frail and elderly, and are at high risk from surgery, anesthesia, and opioid and bed rest-related complications. Hip fractures are also a major public health concern. They are common, expensive to treat, and associated with poor outcomes. Despite this there are no published descriptions of the use of OSA and LIA to enable day of surgery mobilization in patients with hip fractures. We present 3 patients who underwent hip fracture surgery according to an enhanced recovery protocol that incorporated all 3 interventions. In each case day of surgery mobilization was achieved safely and comfortably, without requirement for strong opioids postoperatively. The cases demonstrate that these interventions can be well tolerated by patients with hip fracture, including those with impaired mobility or cognitive function. The protocol is compatible with all common operations for hip fracture, and with spinal or general anesthesia. It is inexpensive and requires minimal expertise. It may have the potential to improve care and shorten hospital stay, while reducing cost. Further investigation is required.