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Wennberg, P., Möller, M., Sarenmalm, E. K. & Herlitz, J. (2020). Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures. International Emergency Nursing, Article ID 100825.
Open this publication in new window or tab >>Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures
2020 (English)In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, article id 100825Article in journal (Refereed) Epub ahead of print
Abstract [en]

BACKGROUND: Pain management needs to be comprehensively investigated in patients with hip fractures, as it represents a fast-growing challenge to emergency care. The purpose of this study was to describe reported pain in patients with suspected hip fractures in a prehospital setting.

METHODS: In this observational study, 1,426 patients with a suspected hip fracture were included. Dynamic and static pain were assessed on the arrival of the emergency medical services (EMS) and on hospital admission using the Numerical Rating Scale (NRS), if feasible, and the Behaviour Rating Scale (BRS), if not.

RESULTS: On EMS arrival, the median dynamic NRS pain score was eight and 84% of the patients had severe or moderate dynamic pain according to the BRS. On admission to hospital, the median dynamic NRS pain score was reduced to five and 45% of the patients had reduced dynamic pain according to the BRS. Among all patients, the NRS was judged to be feasible and was therefore used in 36%. Furthermore, there was an association between the decrease in pain and the increase in the number of administered medications, as well as the duration of prehospital care.

CONCLUSIONS: Patients with suspected hip fractures suffered substantial pain on EMS arrival. Only half experienced a reduction in pain on hospital admission and only 75% received pain-relieving medication.

Place, publisher, year, edition, pages
Elsevier, 2020
Keywords
Analgesia, Emergency medical services, Hip fracture, Pain, Pain management, Pain measurement
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-79933 (URN)10.1016/j.ienj.2019.100825 (DOI)32029418 (PubMedID)
Available from: 2020-02-20 Created: 2020-02-20 Last updated: 2020-02-20Bibliographically approved
Wennberg, P., Möller, M., Herlitz, J. & Kenne Sarenmalm, E. (2019). Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition. BMC Geriatrics, 19(1), Article ID 252.
Open this publication in new window or tab >>Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition
2019 (English)In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, no 1, article id 252Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Impaired cognition is a major risk factor for perioperative delirium. It is essential to provide good pain control in patients with hip fractures and especially important in patients with severely impaired cognitive status, as they receive less pain medication, have poorer mobility, poorer quality of life and higher mortality than patients with intact cognition. The purpose of this study was to examine the association between preoperative pain management with nerve blocks and cognitive status in patients with hip fractures during the perioperative period.

METHODS: One hundred and twenty-seven patients with hip fractures participating in a double-blind, randomised, controlled trial were included in this study. At hospital admission, a low-dose fascia iliaca compartment block (FICB) was administered as a supplement to regular analgesia. Cognitive status was registered on arrival at hospital before FICB and on the first postoperative day using the Short Portable Mental Status Questionnaire.

RESULTS: Changes in cognitive status from arrival at hospital to the first postoperative day showed a positive, albeit not significant, trend in favour of the intervention group. The results also showed that patients with no or a moderate cognitive impairment received 50% more prehospital pain medication than patients with a severe cognitive impairment. FICB was well tolerated in patients with hip fractures.

CONCLUSION: Fascia iliaca compartment block given to patients with hip fractures did not affect cognitive status in this study. Patients with a cognitive impairment may receive inadequate pain relief after hip fracture and this discrimination needs to be addressed in further studies.

TRIAL REGISTRATION: EudraCT number 2008-004303-59 date of registration: 2008-10-24.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Cognitive impairment, Cognitive status, Hip fractures, Nerve block, Pain, Pain management, Perioperative care
National Category
Orthopaedics Geriatrics
Identifiers
urn:nbn:se:oru:diva-76426 (URN)10.1186/s12877-019-1266-0 (DOI)000485322000002 ()31510918 (PubMedID)2-s2.0-85072099268 (Scopus ID)
Note

Funding Agencies:

Region Örebro County  

Skaraborg Hospital 

Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2019-11-15Bibliographically approved
Wennberg, P. (2019). Pain management in older persons with hip fractures. (Doctoral dissertation). Örebro: Örebro University
Open this publication in new window or tab >>Pain management in older persons with hip fractures
2019 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to evaluate the preoperative management of pain from the perspectives of a literature overview, emergency medical service pain management, an intervention with a fascia iliaca compartment block and the association between cognitive status and the treatment of pain. Paper 1 is an integrative review of the literature on emergency care in patients with hip fractures or suspected hip fractures. Pain is a major problem for patients suffering a hip fracture when waiting for surgery and it is challenging for health care to provide sufficient pain relief. Listening to the patient’s narrative and the mandatory use of pain scales and pain documentation are necessary to deepen our understanding of individual patients’ needs. Paper 2 is a prospective observational study that explored the prehospital pain levels in 1,426 patients with suspected hip fractures. Furthermore, this study evaluated prehospital pain management. At the site of the injury, patients with hip fractures are often in substantial pain. Seventy-five per cent of the patients received pain relief from the emergency medical service (EMS) care providers and the pain relief was often effective. Several of the patients that did not receive prehospital pain relief had moderate to severe pain. Paper 3 is a randomised placebo-controlled double-blind trial (RCT) of 127 patients waiting for surgery. This RCT evaluated the effect of fascia iliaca compartment blocks (FICB) in relation to pain and medical pain relief, when added to regular preoperative analgesia. FICB improved pain relief when compared with regular analgesia alone (p=0.002). Paper 4 examined whether preoperative pain management with FICB could have an effect on cognitive status in the same 127 patients that were included in Paper 3. No impact on cognitive impairment was proven in this study. Patients with severe cognitive impairment received significantly lower doses of prehospital morphine than patients with higher cognitive status. Prehospital and hospital pain management need to improve. Pain management is especially challenging in persons with cognitive impairment.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2019. p. 70
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 197
Keywords
Pain, Pain management, Hip fractures, Cognitive status, Nerve blocks, Emergency medical services
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-75191 (URN)978-91-7529-301-1 (ISBN)
Public defence
2019-10-18, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-11-04Bibliographically approved
Wennberg, P., Norlin, R., Herlitz, J., Sarenmalm, E. K. & Möller, M. (2019). Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial. International Journal of Orthopaedic and Trauma Nursing, 33, 35-43
Open this publication in new window or tab >>Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial
Show others...
2019 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 33, p. 35-43Article in journal (Refereed) Published
Abstract [en]

Introduction: Pain management in patients with hip fractures is a major challenge for emergency care. The objective of this study was to evaluate whether the supplementation of pre-operative analgesia with low-dose fascia iliaca compartment block (FICB) compared with placebo would improve pain relief in patients with hip fractures.

Methods: A double-blind, randomized, controlled trial was conducted on 127 patients. At hospital admission, a low-dose FICB was administered to patients with hip fractures as a supplement to regular pre-operative analgesia. Patients with and without cognitive impairment were included. The instruments used were a visual analogue scale (VAS), a numerical rating scale and a tool for behavior related pain assessment. The primary endpoint was the change in reported pain on movement from hospital admission to two hours after FICB.

Results: The intervention group showed improved pain management by mean VAS score for pain on movement compared with the control group (p = 0.002).

Conclusions: Our results support the use of low-dose FICB as a pain-relieving adjuvant to other analgesics when administered to patients with a hip fracture.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Hip fractures, Pain, Nerve block, Pain management, Fascia iliaca compartment block, Analgesia
National Category
Nursing
Identifiers
urn:nbn:se:oru:diva-74410 (URN)10.1016/j.ijotn.2018.11.003 (DOI)000467622900006 ()30876869 (PubMedID)2-s2.0-85065780869 (Scopus ID)
Note

Funding Agency:

Skaraborg Hospital - Örebro County Council

Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-09-25Bibliographically approved
Wennberg, P., Andersson, H. & Wireklint Sundström, B. (2018). Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature. International Journal of Orthopaedic and Trauma Nursing, 29, 16-31
Open this publication in new window or tab >>Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
2018 (English)In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, p. 16-31Article, review/survey (Refereed) Published
Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Hip fractures, Pain, Pain assessment, Pain management, Cognitive impairment, Emergency care
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Nursing
Identifiers
urn:nbn:se:oru:diva-67032 (URN)10.1016/j.ijotn.2017.11.002 (DOI)000432461300004 ()29631852 (PubMedID)2-s2.0-85046756618 (Scopus ID)
Available from: 2018-05-18 Created: 2018-05-18 Last updated: 2019-09-25Bibliographically approved
Wennberg, P., Möller, M., Sarenmalm, E. & Herlitz, J.Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fractures.
Open this publication in new window or tab >>Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fractures
(English)Manuscript (preprint) (Other academic)
National Category
Other Health Sciences
Identifiers
urn:nbn:se:oru:diva-76738 (URN)
Available from: 2019-09-25 Created: 2019-09-25 Last updated: 2019-09-25Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-7690-1735

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