Between Heaven and Hell: Experiences of Preoperative Pain and Pain Management among Older Patients with Hip Fracture

Unneby, Anna; Gustafson, Yngve; Olofsson, Birgitta

doi:10.1177/23779608221097450

Cited by 7 publications

(6 citation statements)

References 46 publications

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“…During the preoperative phase, preparations such as a surgery shower must be made before surgery. A study from Unneby et al (2022) showed that some patients experienced the surgery shower to be the worst part, while a randomized controlled study did not find any significant differences in preoperative delirium when comparing FNB and opioids ( Unneby et al, 2020 ). However, in the present study, participants highlighted how patients suffered less delirium when receiving an FNB instead of opioids.…”

Section: Discussionmentioning

confidence: 99%

“…Particularly nurses with more extended experience seem to prefer alternative pain management ( Shoqirat et al, 2019 ). A study from Unneby et al (2022) showed that patients suggested limiting opioids and that FNB is an excellent alternative if opioids cause side effects.…”

Section: Introductionmentioning

confidence: 99%

“…Communication regarding pain is described as challenging when patients develop delirium or are cognitively impaired ( Ivarsson et al., 2018 ). Patients had described how FNB made them feel relaxed and relied on the analgesic effect after receiving an FNB, causing them not to feel pain when staff performed nursing actions ( Unneby et al., 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures—A Qualitative Study

Unneby

2023

SAGE Open Nursing

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Introduction Hip fractures among older people are common worldwide, and it is often associated with preoperative pain. Due to increased comorbidity and high age, traditional pain relief can be a challenge. An alternative to traditional pain relief is a femoral nerve block, which is safe and suitable for anesthesia and analgesia for hip fractures among patients with or without dementia. It is essential to provide adequate pain management, and nurses report negative attitudes toward opioids and seem to prefer alternative pain management. To our knowledge, no study has focused on staff's experiences of nursing care for patients treated with femoral nerve block. Aim To describe staff's experiences providing nursing care in preoperative pain and pain management to older patients with a hip fracture who received a femoral nerve block. Design A qualitative exploratory design. Method Semistructured interviews with 19 nurses or assistant nurses in an orthopedic ward or emergency department. They were experienced in caring for patients with hip fractures who received treatment with a femoral nerve block. The interviews were subjected to qualitative content analysis. Results Staff described the femoral nerve block as setting the agenda when caring for older patients with hip fractures in the preoperative phase. The outcome of the femoral nerve block affected nursing care, depending on if the femoral nerve block was successful or not. Nursing care requires timing, with a need for staff orienting to time and customizing their communication. Further, staff faced ethical challenges regarding doing good and not harm, relieving pain, and avoiding side effects. Conclusions The femoral nerve block was an important issue for nursing staff in patients with hip fractures in the preoperative phase. Our results point toward the benefits of giving femoral nerve blocks as soon as possible to facilitate nursing care, however, this should be studied in future research.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures—A Qualitative Study

Unneby

2023

SAGE Open Nursing

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“…In addition, most of the studies on pain management in these patients are focused on the post-operative pain, as if patients’ preoperative pain is not recognized as serious pain. While in a recent study conducted by Unneby et al even though all of the patients received femoral nerve blockades and proper intravenous analgesics, the preoperative pain perceived by patients was describes as “Hovering between heaven and hell” meaning that their pain intensity ranged from having no pain to the worst pain they had ever experienced [ 37 ]. They also reported that some patients did not remember their pain or the pain management they had received due to their memory loss; therefore, having no verbal complaint regarding pain does not necessarily imply the absence of pain in geriatric patients and proper pain management options with least possible adverse events must be introduced for these patients.…”

Section: Discussionmentioning

confidence: 99%

The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial

Kheiri

Aghdam

Motififard

et al. 2023

BMC Musculoskelet Disord

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Background Hip fractures are common in elderly patients. The surgery is usually delayed due to underlying conditions, and pain control is crucial while the patient is cleared for surgery. In this randomized controlled trial (RCT) study, we hypothesized that the application of skin traction in patients with intertrochanteric fracture does not significantly change the Visual Analogue Score (VAS) of pain. Methods This is a prospective, single institution, parallel randomized controlled trial. Two hundred and twenty-nine patients with isolated intertrochanteric fractures were enrolled in the study. Patients with neurologic issues, drug addiction, scars or swelling, or vascular issues at the site of skin traction application were excluded from the study. Patients were divided into two groups: group A included 97 patients, and group B included 95 patients. Skin traction was applied for group A, while only a soft pillow was put beneath the patients’ knees in the other group. The VAS score was measured after the diagnosis, two hours before the operation, and 24 h after the surgery. The morphine dosage administered per day was documented for both groups. Results After excluding patients with postoperative delirium, 154 patients (55 males and 99 females) with isolated intertrochanteric fractures (69 right-sided and 85 left-sided), and a mean age of 70 ± 10 remained in the study. There were no significant differences between the two groups regarding age, gender, and mean time from injury to admission (P > .05). The mean VAS score measures and morphine dosage administered per day were not significantly different between the two groups (P > .05). Both groups experienced significant pain relief 24 h postoperatively (P < .001). Conclusion Pre-operative skin traction application affected neither the patients' VAS scores nor the mean morphine dosage per day in patients with isolated intertrochanteric fractures. Our data does not support the routine application of pre-operative skin traction in patients with intertrochanteric fractures. Trial registration The project was registered in the Iranian Registry of Clinical Trials (registration reference: IRCT20180729040636N3, registration date: 01/07/2020). Level of evidence 1.

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“…Pain medication was mentioned as a reason for well-managed pain, but some patients claimed that pain relief did not reduce pain and that opioids caused nightmares, hallucinations, and worry about death, prompting them to refuse pain relief. [12] The downsides of intravenous administration include high dosage, limited analgesic efficacy, and the possibility of severe postoperative nausea and vomiting. [13] This paper prospectively analyzes the effects of different analgesic methods on pulmonary function after the hip fracture in the elderly.…”

Section: Introductionmentioning

confidence: 99%

Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study

Wang,

Xu,

Kang

et al. 2023

Medicine

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Background: To investigate the effect of different analgesic methods on lungs in elderly patients with hip fractures. Methods: A prospective study was conducted on 78 elderly hip fracture patients undergoing spinal anesthesia for surgery, where 3 analgesic methods were used: postoperative Patient-controlled intravenous analgesia pump (PCIA) (group I), pre and postoperative PCIA (group II), and preoperative fascia iliaca compartment block (FICB) + postoperative PCIA (group III). The following indicators were monitored at admission (T1), on the day of surgery before anesthesia (T2), and 7 days after surgery (T3): heart rate (HR), respiratory rate (RR), forced expiratory volume during the first second, arterial partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), C-reactive protein (CRP), and interleukin 6 (IL-6). Pulmonary complications such as pulmonary atelectasis and respiratory insufficiency were analyzed. Results: The HR, RR, forced expiratory volume during the first second, PaO2, PaCO2, IL-6, and CRP levels at T1 after fracture did not significantly differ among the 3 groups (P > .05). After different analgesic treatments post-admission, all indicators at T2 were significantly higher in group I than in groups II and III (P < .05), while there was no significant difference between groups II and III (P > .05). At T3, there were no significant differences in RR, HR, PaO2, PaCO2, and CRP levels among the groups (P > .05), but IL-6 levels at T3 were significantly higher in group I than in groups II and III (P < .05). Conclusion: The use of effective pain relief during surgery can help protect the lung function of elderly patients with hip fractures. When using PCIA with FICB before surgery, respiratory performance may be better protected compared to using unsustained analgesia. This could be due to a decrease in the levels of inflammatory markers such as CRP and interleukin-6.

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Between Heaven and Hell: Experiences of Preoperative Pain and Pain Management among Older Patients with Hip Fracture

Cited by 7 publications

References 46 publications

The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures—A Qualitative Study

The Femoral Nerve Block Setting the Agenda for Nursing Care of Older Patients With hip Fractures—A Qualitative Study

The effect of skin traction on pain relief in patients with isolated intertrochanteric fractures, a randomized clinical trial

Effect of different analgesic treatments on the pulmonary function in elderly hip fracture patients: A prospective study

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