Low dose spinal for hip fracture
Research type
Research Study
Full title
An observational cohort database study of the haemodynamic effects of low-dose spinal anaesthesia for hip fracture repair.
IRAS ID
279652
Contact name
Stuart White
Contact email
Sponsor organisation
Clinical Research Facility
Duration of Study in the UK
0 years, 3 months, 1 days
Research summary
Approximately 65, 000 hip fractures occur in the UK each year, and more than 99% are repaired by surgery [1]. Roughly half of patients receive spinal anaesthesia, where a small amount (usually less than half a teaspoonful) of local anaesthetic is injected into the lower back, around the nerves that go to and from the hip.
Low blood pressure is very common during surgery (at least > 30%, depending on definition) [2], and appears to be linked to a greater chance of death within a month after surgery [3].
There are 2 main ways of managing low blood pressure during surgery: treatment and prevention. Treatments (fluids, drugs) have side effects in the older, frailer population with hip fracture. Prevention involves giving anaesthesia at lower doses. National guidelines recommend that lower doses are given [4], but this recommendation is based on historical research selectively involving younger, fitter people having hip fracture surgery [5, 6]. Importantly, these studies did not record blood pressure either accurately or often enough.
The ASAP 2 study suggested that a safe level of low blood pressure occurs when only 1.5 mls of spinal anaesthesia is given, and we have been using this amount in Brighton since 2011. Recently, a colleague and I have reported a way of transferring vital signs data from anaesthetic monitors to storage computers for medicolegal purposes (e.g. in Coroner’s investigations: approximately 4000 people in the UK die annually within a month of hip fracture surgery) [7].
However, analyzing such observational data should also allow us to describe accurately how blood pressure changes around the time of surgery, and in patient groups that are normally excluded from prospective research (e.g. the very old, the very frail, people with dementia). By comparing this data to published national data from the ASAP 1 study, I hope to determine whether lower doses of spinal anaesthesia are linked with a lower rate of low blood pressure during surgery, potentially improving people’s survival and recovery after hip fracture.
REC name
East Midlands - Derby Research Ethics Committee
REC reference
22/EM/0122
Date of REC Opinion
15 Jun 2022
REC opinion
Further Information Favourable Opinion