Background:The fast-track concept refers to all phases of perioperative care: Preoperative, intraoperative, and postoperative strategies. Although most research has focused on adherence to medication, adherence also encompasses numerous health-related behaviors. The aim of this prospective study was to determine the attitudes and awareness among health professionals involved in the treatment of elderly patients with fractures of the femur and the results of 400 patients.Methods:The postoperative protocol acceleration was presented to various hospital departments through four seminars. Questionnaire with four ex-residents in the Department of Anesthesiology was conducted. Every 6 months, the results of project implementation to all departments were presented. It was considered adherence to the project when the professionals agreed with all the steps and routines of the project. Patients underwent spinal anesthesia with postoperative analgesia by lumbar plexus block.Results:All departments involved in the treatment of elderly patients’ adhered completely to the project and reported the importance of preanesthetic visit, the explanations of design, and reduction of fasting period. Just one anesthetist completely adhered to the project. No former resident of anesthesia joined the program. All parameters studied in 400 patients compared with the data before the project showed a reduction from 21.38% to 100%.Conclusion:Improving adherence requires a continuous and dynamic process. We can be inferred that the implementation of fast-track project Brazilian Public Health System (Sistema Único Saúde, SUS) costs decreased with elderly patients with hip fractures. The anesthesiologist was the major obstacle to deployment to all patients.

The difference in density between the cerebrospinal fluid (CSF) and local anaesthetic solutions should be considered as a means of restricting drug distribution in the subarachnoid space. Conventional spinal anaesthesia may not be suitable for routine use in outpatients and anaesthetists should familiarise themselves with techniques that are associated with a rapid recovery profile. Using a small dose of either hypobaric or hyperbaric local anaesthetic injected at low speed through a directed needle in patients lying in the lateral position for 15 to 30 minutes can result in preferential development of spinal anaesthesia on the operated side. Unilateral spinal anaesthesia may be indicated for short procedures involving only one of the lower limbs. Potential haemodynamic benefits have increased interest in methods achieving unilateral spinal anaesthesia, because hypotension is a common complication of spinal anaesthesia with larger doses of local anaesthetic 1. When haemodynamic change was compared between bilateral and unilateral spinal block from the same dose of hyperbaric bupivacaine (8 mg), the frequencies of hypotension were 22.4% and 5%, respectively 2. The advantages of unilateral or selective versus conventional subarachnoid anaesthesia are better haemodynamic stability 1,2,5,6 , faster motor and sensory recovery 2-4 and decreased urinary retention 3,4,6,7. Unilateral spinal anaesthesia is associated with a lower rate of cardiovascular complications due to less sympathetic block than bilateral spinal anaesthesia 5. The patients' satisfaction with the unilateral technique appears high 3,4,8,9. The rationale behind our approach was to produce spinal anaesthesia restricted to the operative side alone and to obtain surgical anaesthesia just sufficient for the duration of surgery. The primary