Evidence Review Conducted for the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery: Focus on Anesthesiology for Hip Fracture Surgery

Anesth Analg. 2019 Jun;128(6):1107-1117. doi: 10.1213/ANE.0000000000003925.

Abstract

Enhanced recovery after surgery (ERAS) protocols represent patient-centered, evidence-based, multidisciplinary care of the surgical patient. Although these patterns have been validated in numerous surgical specialities, ERAS has not been widely described for patients undergoing hip fracture (HFx) repair. As part of the Agency for Healthcare Research and Quality Safety Program for Improving Surgical Care and Recovery, we have conducted a full evidence review of interventions that form the basis of the anesthesia components of the ERAS HFx pathway. A literature search was performed for each protocol component, and the highest levels of evidence available were selected for review. Anesthesiology components of care were identified and evaluated across the perioperative continuum. For the preoperative phase, the use of regional analgesia and nonopioid multimodal analgesic agents is suggested. For the intraoperative phase, a standardized anesthetic with postoperative nausea and vomiting prophylaxis is suggested. For the postoperative phase, a multimodal (primarily nonopioid) analgesic regimen is suggested. A summary of the best available evidence and recommendations for inclusion in ERAS protocols for HFx repair are provided.

Publication types

  • Research Support, U.S. Gov't, P.H.S.
  • Review

MeSH terms

  • Analgesics / therapeutic use
  • Anesthesiology / methods*
  • Anesthesiology / standards*
  • Anesthetics / adverse effects
  • Anesthetics / therapeutic use
  • Arthroplasty, Replacement, Hip / methods*
  • Evidence-Based Medicine
  • Hip Fractures / surgery*
  • Humans
  • Interdisciplinary Communication
  • Nerve Block
  • Pain Management
  • Patient Safety
  • Patient-Centered Care
  • Perioperative Care / methods
  • Perioperative Period
  • Randomized Controlled Trials as Topic
  • United States
  • United States Agency for Healthcare Research and Quality

Substances

  • Analgesics
  • Anesthetics