This study evaluates the effectiveness of a new Brain Health Protocol implemented in geriatric hip fracture population. A total of 575 patients were analyzed, revealing significant reduction in the incidence of postop delirium (20.2% vs 8.2%, p=.0045), and length of stay (LOS) in acute hospital (10.69days vs 9.01days, p=.036). The time in Post Anaesthesia Care Unit (PACU) was similar before or after protocol implementation (63.3mins vs 66.0mins, p=.233). These findings suggest that the new Brain Health Protocol enhances postoperative recovery, leading to reduced hospital LOS. Further studies are warranted to validate these results and explore long-term outcomes. 

This presentation outlines a comprehensive Brain Health Initiative aimed at reducing postoperative delirium (POD) and postoperative cognitive dysfuction (POCD) in colorectal surgery patients. The program integrates preoperative cognitive screening, cognitive training and patient education; intraoperative anaesthetic and analgesic protocols; inpatient delirium prevention bundles involving ward and recovery nurses and post-operative delirium screening and cognitive assessment. Findings from a local cross-sectional study of POD following major intra-abdominal surgery and the validation of using 4AT screening tool for POD in this context will be shared, followed by a discussion of the benefits, possibilities and challenges of engaging a multi-disciplinary team for BHIC within the HA service framework.

Neurolysis, the targeted disruption of neural pathways through thermal or chemical means, represents a valuable intervention for pain management across various clinical contexts. At Queen Elizabeth Hospital, our pain service has successfully implemented neurolytic procedures for acute, chronic, and cancer-related pain conditions. This presentation focuses specifically on our approach employing neurolysis for geriatric hip fracture patients when conventional management is not feasible.


Our approach addresses a critical clinical challenge: elderly patients with femoral neck or trochanteric fractures who present with poor premorbid functional status, multiple comorbidities, and concurrent medical conditions. These factors collectively elevate anaesthetic and surgical risks, often rendering conventional fracture fixation procedures hazardous. For this vulnerable population, effective pain management becomes paramount when definitive surgical intervention is contraindicated.


The neurolytic technique involves a precise two-step procedure targeting the articular branches of the hip joint. Initial injection of local anaesthetics confirms accurate needle placement and provides immediate analgesia, followed by administration of absolute alcohol to achieve long-lasting neural disruption. This approach has been standardized with comprehensive pre-procedural assessment protocols and dedicated follow-up programs to ensure optimal outcomes.


Preliminary results from our case series are promising, demonstrating significant pain reduction and improved mobility within the constraints of patients' baseline functional limitations. More importantly, this intervention has allowed for enhanced quality of life for patients who would otherwise experience prolonged, poorly controlled pain.


This presentation will detail our patient selection criteria, procedural technique, outcome measures, and case examples illustrating the efficacy of this approach in this challenging patient population.

Perioperative pain management in hip fracture patients is critical for enhancing recovery and minimizing complications. Effective analgesia not only alleviates immediate post-operative discomfort but also facilitates early mobilization and rehabilitation. Multimodal approaches, including regional anaesthesia and systemic analgesics have shown to improve pain control and reduce opioid consumption.