Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture – A randomised controlled trial.

Unneby, Anna; Svensson, Olle; Gustafson, Yngve; Bergström, Ulrica

doi:10.1016/j.injury.2020.04.013

Cited by 24 publications

(55 citation statements)

References 43 publications

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“…However, it is hard for us to identify the relationship between them and POD for the lack of pre-operative records. The prevalence of POD varied from 10.5 to 42.0% in previous studies (25)(26)(27)(28)(29). The incidence of POD in this study was 19.3%, which is consistent with the results of previous studies.…”

Section: Discussionsupporting

confidence: 92%

Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

et al. 2022

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This study aimed to determine the relationship between hemoglobin (Hb) concentration and post-operative delirium (POD) in elderly patients undergoing femoral neck fracture (FNF) surgery and to investigate whether the change in Hb concentration is associated with POD and the risk factors for POD. A total of 889 patients admitted with FNF between January 2016 and December 2020 were enrolled in this single-center, retrospective, case–control study. Hb concentrations were determined at admission and post-operative day 1 and the change in Hb concentration was defined as the absolute value of difference in pre-operative and post-operative Hb concentration. POD was assessed using the Confusion Assessment Method for the Intensive Care Unit (ICU) or the Confusion Assessment Method once a daily after surgery. The logistic regression analysis was performed for statistical analysis. In total, 172 (19.3%) patients developed POD and 151 (87.8%) patients developed POD within post-operative 3 days. Low pre-operative Hb concentration [p = 0.026, odds ratio (OR) = 0.978] and significant change in Hb concentration (p = 0.006, OR = 1.033) were significantly associated with POD. After excluding change in Hb concentration or pre-operative Hb concentration, neither of them was significantly associated with POD (p > 0.05). The interaction analysis of change in Hb concentration and pre-operative Hb concentration in the logistic regression model was negative. There was no significant relationship between post-operative Hb concentration and POD. Age (p < 0.001, OR = 1.072), stroke history (p = 0.003, OR = 2.489), post-operative ICU transfer (p = 0.007, OR = 1.981), and visual analog scale score within post-operative 2 days (p1 = 0.016 and p2 = 0.006) were independently associated with POD in the logistic regression analysis. Patients with low pre-operative Hb concentrations and high changes in Hb concentration seem to have an increased risk of POD and should receive more attention. Old age, stroke history, post-operative ICU transfer, and pain within post-operative 2 days were significantly associated with POD.

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Section: Discussionsupporting

confidence: 92%

Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

et al. 2022

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“…Chuan et al (2020) examined an analgesia bundle of care using femoral nerve blocks aimed at reducing multiple opioid use in particular intravenous morphine which showed reduced incidence of delirium in the intervention group. Unneby et al (2020) hypothesised that providing adequate analgesia via femoral nerve block may reduce the incidence of delirium. However, according to Unneby et al (2020) this protective factor may outweigh non‐modifiable risk factor of dementia.…”

Section: Resultsmentioning

confidence: 99%

“…Unneby et al (2020) hypothesised that providing adequate analgesia via femoral nerve block may reduce the incidence of delirium. However, according to Unneby et al (2020) this protective factor may outweigh non‐modifiable risk factor of dementia. No specific guides to pain management were provided in the reviewed articles.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, Mini‐Mental State Examination (MMSE) is noted as a cognitive assessment tool in six articles, generally to exclude participants who are cognitively impaired (including delirium and dementia) or to assess baseline cognition (Coburn et al, 2018; Patel et al, 2018; Sieber et al, 2018; Smith et al, 2017; Unneby et al, 2020; Wang et al, 2015). Amongst the literature reviewed, there were multiple other screening and delirium diagnostic tools used.…”

Section: Resultsmentioning

confidence: 99%

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Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review

White¹,

Coyne²,

Grealish

2021

Journal of Clinical Nursing

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Background Delirium is a common adverse event in older patients undergoing hip fracture repair surgery. The impact of hospital‐acquired delirium during intraoperative phase of their treatment can have a significant impact on post‐operative outcomes. While non‐pharmacological, multicomponent delirium prevention interventions are considered standard practice in acute medical units, delirium management in the intraoperative setting is less clear. Objectives The aim was to identify evidence‐based delirium management interventions which are, and could be, undertaken within the intraoperative setting for older patients undergoing hip fracture repair surgery. Design A scoping review following the principles developed by Arksey and O’Malley (2005). Data Sources Seven databases including Cochrane, CINAHL, Embase, MEDLINE, PsychINFO, PubMed and SCOPUS were systematically searched. The search was limited to the last 11 years (2009–2020). Research studies included both primary and secondary sources of evidence. Results A total of 2464 articles were initially identified. These articles were further refined using keyword searches and exclusion criteria, with a final set of 16 articles meeting the inclusion criteria. Three main themes were as follows: anaesthetic‐related interventions used to prevent delirium; recognising non‐modifiable and potentially modifiable risk factors; and screening and diagnosis of delirium. Conclusions While there is a strong focus on anaesthetist‐led interventions in the intraoperative setting, there are opportunities for more nurse‐led interventions through adequate pain management and haemodynamic monitoring that require further research. Identifying the best test for screening and diagnosing delirium in the intraoperative setting requires further research.

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“…However, the study has a limitation of heterogeneity and lack of risk stratification. Unneby et al reported that femoral nerve block (FNB) did not reduce the incidence of postoperative delirium in patients with hip fracture [27]. They focused on patients with dementia, and a large proportion developed delirium (FNB group vs. placebo group: 50/52 vs. 55/57) regardless of FNB use.…”

Section: Incidence Of Deliriummentioning

confidence: 99%

Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture

Lim

Koh

Kim

et al. 2021

JCM

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Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.

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Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture – A randomised controlled trial.

Cited by 24 publications

References 43 publications

Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Hemoglobin Concentration and Post-Operative Delirium in Elderly Patients Undergoing Femoral Neck Fracture Surgery

Management of delirium within intraoperative settings for older adults with hip fracture: a scoping review

Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture

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