[Perioperative management of trochanteric femoral fractures : Fasting, fluid therapy and multimodal pain management as underappreciated factors].

backgroundTrochanteric femoral fracture is the most frequent proximal femur fracture in older adults and is associated with substantial perioperative morbidity and mortality. While surgical technique, anticoagulation and orthogeriatric care are widely discussed, the nursing and organisational levers of the perioperative pathway, namely fasting, fluid therapy and pain management, often remain underappreciated.

objectiveTo review the evidence on a liberalised preoperative fasting policy (sip till send), goal-directed fluid therapy, and peripheral nerve blocks with and without continuous catheters with regard to pain control, postoperative delirium and functional outcome.

methodsSelective narrative review of literature published within the last decade, including systematic reviews, randomised trials and national recommendations.

conclusionClear fluids up to the call to theatre are safe and reduce thirst, hunger and volume depletion. Liberal intraoperative fluid administration is associated with higher complication rates; goal-directed therapy with balanced crystalloids is therefore preferable. Peripheral nerve blocks reduce pain, opioid consumption and the incidence of postoperative delirium. Continuous nerve catheters are an attractive option in case of prolonged preoperative waiting times. Bundling these measures within an enhanced-recovery framework is associated with shorter length of stay and improved recovery.