Key result
Preoperative epidural analgesia for hip fracture reduced perioperative cardiac events (RR 0.30; 95% CI 0.14-0.63) and mortality (RR 0.13; 95% CI 0.02-0.98) compared to other pain management.
Why the study?
To examine the effectiveness and safety of epidural analgesia in the presurgical period among patients with hip fracture undergoing surgical repair.
Does preoperative epidural analgesia reduce perioperative cardiac events and death in patients with hip fracture undergoing surgical repair?
Systematic Review (n=221)
Does preoperative epidural analgesia reduce perioperative cardiac events and death in patients with hip fracture undergoing surgical repair?
Preoperative epidural analgesia may significantly reduce perioperative cardiac events and mortality in patients undergoing surgical repair for hip fracture, though evidence is limited by a small number of studies.
Preoperative epidural analgesia may reduce cardiac events and mortality before hip fracture repair; leaves open need for larger RCTs to confirm.
OBJECTIVE: To examine the effectiveness and safety of epidural analgesia in the presurgical period in patients with hip fracture undergoing surgical repair. DESIGN: Systematic review. METHODS: The study protocol was registered with the PROSPERO systematic reviews registry with the (identifier CRD42019140396). Electronic databases were searched for randomized controlled trials comparing preoperative epidural analgesia with other forms of pain management in patients with a hip fracture. The primary outcomes included perioperative cardiac events and death. Pain, noncardiac complications, and adverse effects were also examined as secondary outcomes. The heterogeneity of the included studies was assessed with the I2 statistic, and a random-effects meta-analysis was conducted once sufficient homogeneity was demonstrated. RESULTS: Four studies, which included a total of 221 patients, met the inclusion criteria. Preoperative epidural analgesia resulted in fewer cardiac events, which was a reported outcome in two included studies (relative risk 0.30; 95% confidence interval 0.14-0.63; I2=0%). Preoperative epidural analgesia was also associated with a decreased perioperative mortality rate in a meta-analysis of two studies (relative risk 0.13; 95% confidence interval 0.02-0.98; I2 = 0%). Pain was not pooled because of variability in assessment methods, but preoperative epidural analgesia was associated with reduced pain in all four studies. CONCLUSIONS: Preoperative epidural analgesia for hip fracture may reduce perioperative cardiac events and deaths, but the number of included studies in this systematic review was low. More research should be done to determine the benefit of early epidural analgesia for patients with hip fracture.
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Choi et al. (2021) conducted a systematic review in hip fracture (n=221). Preoperative epidural analgesia vs. other forms of pain management was evaluated on perioperative cardiac events (RR 0.30, 95% CI 0.14-0.63). Preoperative epidural analgesia for hip fracture reduced perioperative cardiac events (RR 0.30; 95% CI 0.14-0.63) and mortality (RR 0.13; 95% CI 0.02-0.98) compared to other pain management.
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