Feasibility of epidural catheter as primary anaesthesia in patients with hip fracture

Introduction: Danish national guidelines advocate preoperative optimization within 4 h and surgical intervention within 24 h for hip fracture patients, a goal often unmet. This study assesses the feasibility of universal epidural administration, aiming to achieve adherence to these guidelines. Method: Data from the Danish Interdisciplinary Registry of Hip Fractures (March-May and September-November 2022) at Godstrup Hospital were analyzed. Patients aged 65 and above were included, with a focus on achieving 75% compliance for epidural administration as the primary surgical anesthesia. Journal audits explored patient characteristics, excluding those with epidural contraindications. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Results: Out of 121 patients administered an epidural, 79% had it as their primary surgical anesthesia. Patient characteristics were comparable between those maintaining and altering the epidural method. Notably, 61% of epidural patients were ready for surgery within 4 h, and 91% underwent surgery within 24 h, aligning with guideline recommendations. However, adherence to the 4 h preoperative optimization guideline was incomplete. Comparisons with alternative anesthesia approaches showed no significant differences in preoperative optimization and surgical intervention times. Conclusion: This study demonstrates the feasibility of a fast-track regime with a preoperative epidural catheter, with 79% adherence to the planned use of epidural as the primary surgical anesthesia. This approach allows for early optimal pain relief without delaying surgery, showcasing potential improvements in adhering to guideline recommendations, especially in achieving timely surgical interventions for hip fracture patients.