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Pain management in older persons with hip fractures
Örebro universitet, Institutionen för hälsovetenskaper.ORCID-id: 0000-0001-7690-1735
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
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.

Ort, förlag, år, upplaga, sidor
Örebro: Örebro University , 2019. , s. 70
Serie
Örebro Studies in Medicine, ISSN 1652-4063 ; 197
Nyckelord [en]
Pain, Pain management, Hip fractures, Cognitive status, Nerve blocks, Emergency medical services
Nationell ämneskategori
Annan hälsovetenskap
Identifikatorer
URN: urn:nbn:se:oru:diva-75191ISBN: 978-91-7529-301-1 (tryckt)OAI: oai:DiVA.org:oru-75191DiVA, id: diva2:1338297
Disputation
2019-10-18, Örebro universitet, Campus USÖ, hörsal C1, Södra Grev Rosengatan 32, Örebro, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2019-07-22 Skapad: 2019-07-22 Senast uppdaterad: 2019-11-04Bibliografiskt granskad
Delarbeten
1. Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
Öppna denna publikation i ny flik eller fönster >>Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
2018 (Engelska)Ingår i: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, s. 16-31Artikel, forskningsöversikt (Refereegranskat) Published
Ort, förlag, år, upplaga, sidor
Elsevier, 2018
Nyckelord
Hip fractures, Pain, Pain assessment, Pain management, Cognitive impairment, Emergency care
Nationell ämneskategori
Hälso- och sjukvårdsorganisation, hälsopolitik och hälsoekonomi Omvårdnad
Identifikatorer
urn:nbn:se:oru:diva-67032 (URN)10.1016/j.ijotn.2017.11.002 (DOI)000432461300004 ()29631852 (PubMedID)2-s2.0-85046756618 (Scopus ID)
Tillgänglig från: 2018-05-18 Skapad: 2018-05-18 Senast uppdaterad: 2019-09-25Bibliografiskt granskad
2. Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fractures
Öppna denna publikation i ny flik eller fönster >>Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fractures
(Engelska)Manuskript (preprint) (Övrigt vetenskapligt)
Nationell ämneskategori
Annan hälsovetenskap
Identifikatorer
urn:nbn:se:oru:diva-76738 (URN)
Tillgänglig från: 2019-09-25 Skapad: 2019-09-25 Senast uppdaterad: 2019-09-25Bibliografiskt granskad
3. Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial
Öppna denna publikation i ny flik eller fönster >>Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial
Visa övriga...
2019 (Engelska)Ingår i: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 33, s. 35-43Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
Elsevier, 2019
Nyckelord
Hip fractures, Pain, Nerve block, Pain management, Fascia iliaca compartment block, Analgesia
Nationell ämneskategori
Omvårdnad
Identifikatorer
urn:nbn:se:oru:diva-74410 (URN)10.1016/j.ijotn.2018.11.003 (DOI)000467622900006 ()30876869 (PubMedID)2-s2.0-85065780869 (Scopus ID)
Anmärkning

Funding Agency:

Skaraborg Hospital - Örebro County Council

Tillgänglig från: 2019-05-28 Skapad: 2019-05-28 Senast uppdaterad: 2019-09-25Bibliografiskt granskad
4. Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition
Öppna denna publikation i ny flik eller fönster >>Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition
2019 (Engelska)Ingår i: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, nr 1, artikel-id 252Artikel i tidskrift (Refereegranskat) 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.

Ort, förlag, år, upplaga, sidor
BioMed Central, 2019
Nyckelord
Cognitive impairment, Cognitive status, Hip fractures, Nerve block, Pain, Pain management, Perioperative care
Nationell ämneskategori
Ortopedi Geriatrik
Identifikatorer
urn:nbn:se:oru:diva-76426 (URN)10.1186/s12877-019-1266-0 (DOI)000485322000002 ()31510918 (PubMedID)2-s2.0-85072099268 (Scopus ID)
Anmärkning

Funding Agencies:

Region Örebro County  

Skaraborg Hospital 

Tillgänglig från: 2019-09-16 Skapad: 2019-09-16 Senast uppdaterad: 2019-10-02Bibliografiskt granskad

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