Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation

Rosario, E. del; Esteve, N.; Sernandez, M. J.; Batet, C.; Aguilar, José

doi:10.1016/j.acpain.2008.02.001

Cited by 16 publications

(5 citation statements)

References 16 publications

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“…There is mounting evidence that the use of femoral nerve blocks can reduce the incidence of delirium in elderly subjects with hip fracture . Abou‐Setta's meta‐analyses support this, identifying moderate strength evidence in favour of statistically reduced incidence of delirium with nerve blockades compared with no blockade .…”

Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care.

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Section: Methodsmentioning

confidence: 99%

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

et al. 2017

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“…Patient outcome may also be improved when older patients receive regional rather than opioid analgesia after surgery. After fixation of a fractured hip, those who received patient-controlled femoral nerve analgesia in addition to regular paracetamol and metamizol were less likely to develop postoperative delirium, were able to sit at the bedside at an earlier stage, and required no SC morphine compared with those given just paracetamol and metamizol, 28% of whom required additional morphine analgesia (Rosario et al, 2008 Level IV).…”

Section: Other Regional Analgesiamentioning

confidence: 99%

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

Cohen

Smit

Andrianopoulos³

et al. 2017

Medical Journal of Australia

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Objectives: This study aimed to assess analgesia provided by acupuncture, alone or in combination with pharmacotherapy, to patients presenting to emergency departments with acute low back pain, migraine or ankle sprain. Design: A pragmatic, multicentre, randomised, assessor‐blinded, equivalence and non‐inferiority trial of analgesia, comparing acupuncture alone, acupuncture plus pharmacotherapy, and pharmacotherapy alone for alleviating pain in the emergency department. Setting, participants: Patients presenting to emergency departments in one of four tertiary hospitals in Melbourne with acute low back pain, migraine, or ankle sprain, and with a pain score on a 10‐point verbal numerical rating scale (VNRS) of at least 4. Main outcome measures: The primary outcome measure was pain at one hour (T1). Clinically relevant pain relief was defined as achieving a VNRS score below 4, and statistically relevant pain relief as a reduction in VNRS score of greater than 2 units. Results: 1964 patients were assessed between January 2010 and December 2011; 528 patients with acute low back pain (270 patients), migraine (92) or ankle sprain (166) were randomised to acupuncture alone (177 patients), acupuncture plus pharmacotherapy (178) or pharmacotherapy alone (173). Equivalence and non‐inferiority of treatment groups was found overall and for the low back pain and ankle sprain groups in both intention‐to‐treat and per protocol (PP) analyses, except in the PP equivalence testing of the ankle sprain group. 15.6% of patients had clinically relevant pain relief and 36.9% had statistically relevant pain relief at T1; there were no between‐group differences. Conclusion: The effectiveness of acupuncture in providing acute analgesia for patients with back pain and ankle sprain was comparable with that of pharmacotherapy. Acupuncture is a safe and acceptable form of analgesia, but none of the examined therapies provided optimal acute analgesia. More effective options are needed. Trial registration: Australian New Zealand Clinical Trials Registry, ACTRN12609000989246.

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“…The results of RNB and delirium in patients with hip fracture are inconsistent. RNB was reported to be associated with less postoperative analgesia, a lower incidence of delirium, and shorter inpatient stay [24,25]. In contrast, Guay et al presented that there were no differences in the incidence of acute confusional state in their Cochrane review based on seven trials with 676 participants [26].…”

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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Does femoral nerve analgesia impact the development of postoperative delirium in the elderly? A retrospective investigation

Cited by 16 publications

References 16 publications

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Regional nerve blockade for early analgesic management of elderly patients with hip fracture – a narrative review

Acupuncture for analgesia in the emergency department: a multicentre, randomised, equivalence and non‐inferiority trial

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

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