ERAS for fractured neck of femurs

Talboys R, Mak M, Modi N, Fanous N, Cutts S. Enhanced recovery programme reduces opiate consumption in hip hemiarthroplasty. Eur J Orthop Surg Traumatol. 2016 Feb;26(2):177-81.

What is already known:

This is an interesting paper as it looks at the introduction of an ERAS program for fractured neck of femurs. This is a high risk emergency population with limited ERAS evidence.

What this paper adds:

This is a retrospective UK study. The authors used a more aggressive analgesic approach including a fascia iliaca block in the ED, a single shot spinal (with no opiate) intraoperatively with TCI propofol sedation. Local anaesthetic was also infiltrated by the surgeon at the end of the procedure. This was all strictly protocolised compared with the pre-ERAS group who either underwent a general anaesthetic with iv opiates or spinal anaesthesia depending on the anaesthetists preference. The authors demonstrated a significant reduction in opiate consumption in the ERAS group however this did not result in a reduced length of stay.

Chris Jones, Guildford.