TY - JOUR

T1 - Pre-operative epidural analgesia in hip fracture patients - A systematic review and meta-analysis

AU - Rubin, Monika Afzali

AU - Stark, Nikolaj Francis

AU - Hårsmar, Simon Julius Chamli

AU - Møller, Ann Merete

N1 - Funding Information: This work was supported by the Department of Anaesthesiology, Herlev‐Gentofte University Hospital, Herlev, Denmark. Publisher Copyright: © 2020 The Acta Anaesthesiologica Scandinavica Foundation. Published by John Wiley & Sons Ltd

PY - 2021

Y1 - 2021

N2 - Background: Hip fracture is a common, painful injury with increasing global incidence. Patients require optimal acute pain management. Systematic reviews have investigated the postoperative use of epidural analgesia and found that it may have advantages over systemic analgesia. It is of interest to determine whether pre-operative use of epidural analgesia is also advantageous. We conducted a systematic review and meta-analyses on the effect of epidural analgesia on pre-operative pain management in hip fracture patients. Methods: We included randomized controlled trials comparing pre-operatively initiated epidural analgesia with any other method of analgesia, in adults aged ≥55 years scheduled for hip fracture surgery. The main outcome was pre-operative pain at rest. Electronic searches of four medical databases were performed. Two authors independently screened for eligibility, extracted data, and assessed risk of bias. We conducted meta-analyses and assessed the certainty of the evidence by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Three articles were included, with 179 randomized patients. All studies compared epidural analgesia with systemic analgesia, one additionally with 3-in-1-block. Meta-analyses of pre-operative pain measurements resulted in a mean difference of −5.85 95% CI [−14.90; 3.19] on a 0-100 Visual Analogue Scale with a p-value of 0.17 and a very low certainty of evidence according to the GRADE rating. Conclusions: We did not find a difference in pre-operative pain at rest between epidural analgesia and any other method of pre-operatively initiated analgesia. The studies were few, of low quality and the difference between the two interventions remains unknown.

AB - Background: Hip fracture is a common, painful injury with increasing global incidence. Patients require optimal acute pain management. Systematic reviews have investigated the postoperative use of epidural analgesia and found that it may have advantages over systemic analgesia. It is of interest to determine whether pre-operative use of epidural analgesia is also advantageous. We conducted a systematic review and meta-analyses on the effect of epidural analgesia on pre-operative pain management in hip fracture patients. Methods: We included randomized controlled trials comparing pre-operatively initiated epidural analgesia with any other method of analgesia, in adults aged ≥55 years scheduled for hip fracture surgery. The main outcome was pre-operative pain at rest. Electronic searches of four medical databases were performed. Two authors independently screened for eligibility, extracted data, and assessed risk of bias. We conducted meta-analyses and assessed the certainty of the evidence by Grading of Recommendations Assessment, Development and Evaluation (GRADE). Results: Three articles were included, with 179 randomized patients. All studies compared epidural analgesia with systemic analgesia, one additionally with 3-in-1-block. Meta-analyses of pre-operative pain measurements resulted in a mean difference of −5.85 95% CI [−14.90; 3.19] on a 0-100 Visual Analogue Scale with a p-value of 0.17 and a very low certainty of evidence according to the GRADE rating. Conclusions: We did not find a difference in pre-operative pain at rest between epidural analgesia and any other method of pre-operatively initiated analgesia. The studies were few, of low quality and the difference between the two interventions remains unknown.

KW - anaesthesiology

KW - epidural

KW - hip fracture

KW - preoperative

KW - regional anaesthesia

U2 - 10.1111/aas.13760

DO - 10.1111/aas.13760

M3 - Review

C2 - 33296497

AN - SCOPUS:85099514927

VL - 65

SP - 578

EP - 589

JO - Acta Anaesthesiologica Scandinavica

JF - Acta Anaesthesiologica Scandinavica

SN - 0001-5172

IS - 5

ER -