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Correspondence  |   August 2003
Preoperative Epidural Placement in Elderly Patients with Hip Fractures: A Request for Essential Information
Author Notes
  • University of Florida College of Medicine, Gainesville, Florida.
Article Information
Correspondence
Correspondence   |   August 2003
Preoperative Epidural Placement in Elderly Patients with Hip Fractures: A Request for Essential Information
Anesthesiology 8 2003, Vol.99, 514. doi:
Anesthesiology 8 2003, Vol.99, 514. doi:
To the Editor:—
I read with interest the recent article by Matot et al.  1 The reduction in adverse preoperative cardiac events was significant enough to warrant study termination following the interim analysis. However, for other healthcare providers to provide these benefits to their patients, the authors’ technique must be strictly adhered to. Missing from the article's Methods section is any mention of premedication before epidural placement and patient positioning for catheter placement. Although these may, at first, seem to be trivial issues, I would suggest otherwise. As the authors specifically noted, pain is increased with even a slight movement of the fractured extremity (see Results and fig. 2 of the article). Because the study hypothesis was “that the use of epidural analgesia during the stressful presurgical  period would decrease the incidence of adverse cardiac events,” it is essential to know if and how the authors decreased the often-excruciating pain during patient positioning for catheter placement. If others attempt to reproduce the favorable outcomes found in this investigation but dramatically increase patients’ pain during catheter placement, they may inadvertently cause an increased stress response and decrease (or negate) the effectiveness of this important preoperative intervention. Therefore, I would like to request that the authors clarify their technique for minimizing pain and the resulting stress response during catheter placement.
Reference
Reference
Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S, Peyser A, Liebergall M: Preoperative cardiac events in elderly patients with hip fracture randomized to epidural or conventional analgesia. A nesthesiology 2003; 98: 156–63Matot, I Oppenheim-Eden, A Ratrot, R Baranova, J Davidson, E Eylon, S Peyser, A Liebergall, M