A national survey into the peri-operative anaesthetic management of patients presenting for surgical correction of a fractured neck of femur

Abstract

We conducted a national postal survey of trauma anaesthetists in the UK to ascertain current practice for the peri-operative anaesthetic management in patients with fractured necks of femur. We received 155 replies from 218 questionnaires sent (71.1% response rate). Regional anaesthesia was preferred by 75.8% of respondents, with 95.5% of these employing a spinal technique. This was generally performed bad side down (45.7%) using ketamine (37.3%) and/or midazolam (41.2%) to aid positioning. In all, 31.4% used fentanyl in the intrathecal injectate, whereas only 5.9% used morphine. Paracetamol and morphine were the most commonly used postoperative analgesic regimens with non-steroidal anti-inflammatory drugs used by only 27.4%. Continuous epidural or nerve block infusions were used rarely. Of the anaesthetists, 50.6% would only request a pre-operative echo if there were suspicious signs or symptoms in patients with a previously undiagnosed heart murmur. The peri-operative management of these patients can be readily improved.