Emergency Department Pain Management Following Implementation of a Geriatric Hip Fracture Program

Abstract

IntroductionOver 300,000 patients in the United States sustain low-trauma fragility hip fractures annually. Multidisciplinary geriatric fracture programs (GFP) including early, multimodal pain management reduce morbidity and mortality. Our overall goal was to determine the effects of a GFP on the emergency department (ED) pain management of geriatric fragility hip fractures.MethodsWe performed a retrospective study including patients age ≥65 years with fragility hip fractures two years before and two years after the implementation of the GFP. Outcomes were time to (any) first analgesic, use of acetaminophen and fascia iliaca compartment block (FICB) in the ED, and amount of opioid medication administered in the first 24 hours. We used permutation tests to evaluate differences in ED pain management following GFP implementation.ResultsWe studied 131 patients in the pre-GFP period and 177 patients in the post-GFP period. In the post-GFP period, more patients received FICB (6% vs. 60%; difference 54%, 95% confidence interval [CI] 45–63%; p<0.001) and acetaminophen (10% vs. 51%; difference 41%, 95% CI 32–51%; p<0.001) in the ED. Patients in the post-GFP period also had a shorter time to first analgesic (103 vs. 93 minutes; p=0.04) and received fewer morphine equivalents in the first 24 hours (15mg vs. 10mg, p<0.001) than patients in the pre-GFP period.ConclusionImplementation of a GFP was associated with improved ED pain management for geriatric patients with fragility hip fractures. Future studies should evaluate the effects of these changes in pain management on longer-term outcomes.

Assessment of Acute Pain Management and Associated Factors among Emergency Surgical Patients in Gondar University Specialized Hospital Emergency Department, Northwest Ethiopia, 2018: Institutional Based Cross-Sectional Study

“…A study done in USA on geriatric hip fracture patients showed that patients who received fascia iliac compartment block (6% vs 60% ) in the ED had a shorter time to first analgesic use (93 minutes VS 103 minutes) and received fewer morphine equivalents in the first 24 hours [17]. In addition, a study done by Beaudoin and his colleagues showed that there is a significant decrease in pain intensity with regional nerve blocks in ED and decreased amount of rescue analgesia [18].…”

Design and Evaluation of a Hospital-Based Educational Event on Fracture Care for Older Adult

“… 26 The effect of a multidisciplinary perioperative care bundle that standardized management in the emergency department, operating theater, and ward has been shown to produce a clinically and statistically significant reduction in the incidence of delirium following hip fracture surgery, and this program included regular education for staff as well as continuous auditing of compliance. 27 , 28 Postoperative outcomes in patients may also benefit from a multidisciplinary rehabilitation model adapted to the patient with dementia, and by redefining results of rehabilitation for these patients. 29 Systematic reviews have shown that the Fracture Liaison Service (FLS) model of care is associated with significant improvement in rates of bone mineral density testing, initiation of osteoporosis treatment, and adherence with treatment for individuals who sustain fragility fractures.…”

Toxicity of the acetyl‑para‑aminophenol group of medicines to intact intervertebral disc tissue cells

“…It is frequently prescribed as an analgesic and antipyretic in the treatment of headache, toothache, migraine, dysmenorrhea, myalgia, neuralgia, musculoskeletal, tonsillectomy pain, the common cold, influenza, and other bacterial and viral infections. It can also be used as a pain controller for numerous cases in neurosurgery and emergency departments, including posterior lumbar laminectomy ( 24 ), vertebral compression fractures ( 25 ), spinal primary and metastatic tumors ( 26 ), post-craniotomy in intracranial pathology surgery ( 27 ), traumatic fractures of bones ( 28 ), urinary colic ( 29 ) and acute appendicitis ( 30 ).…”