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Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial
Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Centre, Region Örebro, Örebro, Sweden.ORCID iD: 0000-0001-7690-1735
Capio Movement, Halmstad, Sweden; Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
The Centre of Prehospital Research in Western Sweden, University College of Borås, Sweden; The Centre of Prehospital Research in Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden.
Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
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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. Vol. 33, p. 35-43
Keywords [en]
Hip fractures, Pain, Nerve block, Pain management, Fascia iliaca compartment block, Analgesia
National Category
Nursing
Identifiers
URN: urn:nbn:se:oru:diva-74410DOI: 10.1016/j.ijotn.2018.11.003ISI: 000467622900006PubMedID: 30876869Scopus ID: 2-s2.0-85065780869OAI: oai:DiVA.org:oru-74410DiVA, id: diva2:1318547
Note

Funding Agency:

Skaraborg Hospital - Örebro County Council

Available from: 2019-05-28 Created: 2019-05-28 Last updated: 2019-09-25Bibliographically approved
In thesis
1. Pain management in older persons with hip fractures
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: 2019-09-25Bibliographically approved

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Wennberg, PärMöller, Margareta

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