oru.sePublications
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition
Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Center, Region Örebro, Örebro, Sweden.ORCID iD: 0000-0001-7690-1735
Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro, Örebro, Sweden.ORCID iD: 0000-0003-2411-1795
Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden.
Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Institute of Health and Care Sciences and Centre for Person-Centred Care, and Institute of Health and Care Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.
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. Vol. 19, no 1, article id 252
Keywords [en]
Cognitive impairment, Cognitive status, Hip fractures, Nerve block, Pain, Pain management, Perioperative care
National Category
Orthopaedics Geriatrics
Identifiers
URN: urn:nbn:se:oru:diva-76426DOI: 10.1186/s12877-019-1266-0ISI: 000485322000002PubMedID: 31510918Scopus ID: 2-s2.0-85072099268OAI: oai:DiVA.org:oru-76426DiVA, id: diva2:1351751
Note

Funding Agencies:

Region Örebro County  

Skaraborg Hospital 

Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2019-10-02Bibliographically 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

Open Access in DiVA

No full text in DiVA

Other links

Publisher's full textPubMedScopus

Authority records BETA

Wennberg, PärMöller, Margareta

Search in DiVA

By author/editor
Wennberg, PärMöller, Margareta
By organisation
School of Health Sciences
In the same journal
BMC Geriatrics
OrthopaedicsGeriatrics

Search outside of DiVA

GoogleGoogle Scholar

doi
pubmed
urn-nbn

Altmetric score

doi
pubmed
urn-nbn
Total: 25 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf