Abstract ID: A30

Abstract Title: Factors related to underutilisation of regional analgesia in patients with hip fractures

Poster Type: Poster

ABSTRACT BODY

Introduction:
Hip fractures are a significant public health issue in an aging society. We conducted a retrospective chart review study in order to identify factors, which interfere with pain management utilizing regional analgesia.
Materials and Methods:
25 charts, which served as a representative sample (1), were drawn at random out of all hip fracture cases treated in 2001 at a Level I trauma center in a university teaching hospital as identified by CPT codes. With IRB approval data were extracted and analyzed in a descriptive manner.
Results and Discussions:
Patient’s age ranged from 15 to 88 years with the majority being caucasian females (67%) older than 70 years.
Underlying neurological disease could be identified in 59% with dementia (18%) as the leading entity. Psychotropic medication was used by 40% at the time of fracture. 34% were severe to moderately disabled on the Rankin scale. Time between hospital admission and surgery was longer than 24 hours in 74% and regional analgesia was utilized in 18% (11% epidural catheter, 7% single shot femoral nerve blocks).
Postoperative DVT-prophylaxis ranged from ASA, s.c. heparin, LMWH to coumadine and was found to be the major factor in preventing the use of continuous epidural analgesia. Other factors included lack of cooperation and/or consent(esp. in demented patients). Time to first mobilization ranged from 1-5 days postoperatively with missing power of the sample to detect any differences between patients with and without regional analgesia.
Conclusion:
We found not only a heterogenous treatment approach regarding pain management but also towards anticoagulation for DVT prophylaxis and rehabilitation, which needs to be standardized in order to utilize continuous catheter techniques for regional analgesia in an optimal way. Staff availability and recognition of potential benefits of regional analgesia by the admitting surgeon seems to be crucial for initiating regional analgesia in the preoperative phase, where consent issues and lack of patient cooperation also play a major role. The study demonstrated that organizational rather than medical reasons were responsible for not using regional analgesia.
References:
1. Nölle-Neumann E. The theory of public opinion. In: Anderson James A, ed. Communication Year Book, 14, Newburry Park 1991: 256-87

ATTACHED FILES

Reg Anesth Pain Med 2004; 29(2):A30