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  • 1.
    Wennberg, Pär
    Örebro University, School of Health Sciences.
    Pain management in older persons with hip fractures2019Doctoral 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.

    List of papers
    1. Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature
    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
    2. 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
    3. Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial
    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
    4. Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition
    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
  • 2.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; Centre for Health Care Sciences, Örebro County Council, Örebro, Sweden.
    Andersson, Henrik
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Wireklint Sundström, Birgitta
    PreHospen - Centre for Prehospital Research, University of Borås, Borås, Sweden; Faculty of Caring Science, Work Life and Social Welfare, University of Borås, Borås, Sweden.
    Patients with suspected hip fracture in the chain of emergency care: An integrative review of the literature2018In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 29, p. 16-31Article, review/survey (Refereed)
  • 3.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Center, Region Örebro, Örebro, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro, Örebro, Sweden.
    Herlitz, Johan
    Prehospen-Centre of Prehospital Research; Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Borås, Sweden.
    Kenne Sarenmalm, Elisabeth
    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.
    Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures: effects on cognition2019In: BMC Geriatrics, ISSN 1471-2318, E-ISSN 1471-2318, Vol. 19, no 1, article id 252Article in journal (Refereed)
    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.

  • 4.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences.
    Möller, Margareta
    Örebro University, School of Health Sciences.
    Sarenmalm, E.K.
    Herlitz, J.
    Evaluation of the intensity and management of pain before arrival in hospital among 3 patients with suspected hip fracturesManuscript (preprint) (Other academic)
  • 5.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Center, Region Örebro, and School of Health Sciences, Örebro University, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Center, Region Örebro.
    Sarenmalm, Elisabeth Kenne
    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, Sweden.
    Herlitz, Johan
    Prehospen-Centre of Prehospital Research, Faculty of Caring Science, Work-Life and Social Welfare, University of Borås, Sweden.
    Evaluation of the intensity and management of pain before arrival in hospital among patients with suspected hip fractures2020In: International Emergency Nursing, ISSN 1755-599X, E-ISSN 1878-013X, article id 100825Article in journal (Refereed)
    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.

  • 6.
    Wennberg, Pär
    et al.
    Örebro University, School of Health Sciences. Research and Development Centre, Skaraborg Hospital, Skövde, Sweden; University Health Care Research Centre, Region Örebro, Örebro, Sweden.
    Norlin, Rolf
    Capio Movement, Halmstad, Sweden; Department of Orthopedics, Örebro University Hospital, Örebro, Sweden.
    Herlitz, Johan
    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.
    Sarenmalm, Elisabeth Kenne
    Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.
    Möller, Margareta
    Örebro University, School of Health Sciences. University Health Care Research Centre, Region Örebro.
    Pre-operative pain management with nerve block in patients with hip fractures: a randomized, controlled trial2019In: International Journal of Orthopaedic and Trauma Nursing, ISSN 1878-1241, E-ISSN 1878-1292, Vol. 33, p. 35-43Article in journal (Refereed)
    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.

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