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Pre‐operative epidural analgesia in hip fracture patients ‐ A systematic review and meta‐analysis
Author(s) -
Rubin Monika Afzali,
Stark Nikolaj Francis,
Hårsmar Simon Julius Chamli,
Møller Ann Merete
Publication year - 2021
Publication title -
acta anaesthesiologica scandinavica
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.738
H-Index - 107
eISSN - 1399-6576
pISSN - 0001-5172
DOI - 10.1111/aas.13760
Subject(s) - medicine , meta analysis , randomized controlled trial , grading (engineering) , hip fracture , anesthesia , visual analogue scale , surgery , evidence based medicine , osteoporosis , civil engineering , alternative medicine , pathology , engineering
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.