Patterns of analgesia for fractured neck of femur in Australian emergency departments

Abstract

Oligoanalgesia for fracture neck of femur in Australian ED is common and time to analgesia tends to be relatively slow. Regional techniques are infrequently used despite their recognized efficacy. Strategies for improving pain management in this cohort of ED patients need to be explored.

Audit of standards of practice in suspected hip fracture

“…Since 30.8% of patients apparently received no analgesia at all, these findings unfortunately seem to concur with those of Holdgate et al (2010) and Pines and Hollander (2008) that a significant proportion of hip-fracture patients do not receive any analgesia within the ED, and those who do often experience long delays before pain-relief is finally administered.…”

“…This is necessary be- cause cardiac problems are a common and potentially serious affliction within elderly patients presenting with a fall (Baraff et al 1997;Davies and Kenny, 1996). There is consensus amongst the literature reviewed that pain is a serious problem presenting in patients with a suspected hip-fracture (FitzSimmons and Wardrope, 2005;Holdgate et al, 2010;Jackson, 2010;Pines and Hollander, 2008;Chambers and Guly, 1993;Herr and Titler, 2008;Morley, 1998). Pain can in itself lead to further complications such as cardiac arrhythmias (Vassiliadis et al, 2002).…”

“…Pain has also been found to be undertreated in the ED in other studies, particularly amongst the elderly (Holdgate et al, 2010;and Pines and Hollander, 2008), therefore it is recommended that the pain assessment and analgesia practices for patients presenting with a suspected hip-fracture are reviewed. Patients should have their pain assessed as soon as possible after their arrival to the department, and the administration of appropriate pain-relief should not be delayed following the initial patient assessment.…”

A case-control study examining inconsistencies in pain management following fractured neck of femur: an inferior analgesia for the cognitively impaired

“…Previous studies have noted that patients with cognitive impairment present with a range of barriers to adequate analgesia which are not normally seen in the elderly population as a whole 26. By splitting the FNOF cases at Wythenshawe Hospital over the course of 12 months into two distinct cohorts, this audit was able to show that the management of pain in cognitively-impaired patients is significantly different to their cognitively-intact counterparts.…”

Ultrasound Guided Femoral Nerve Blocks and the Management of Elder Patients with Hip Fractures

“…Despite the evidence, institutions often face difficulties when implementing FNB protocols. In fact, Holdgate et al revealed that of 36 emergency departments in Australia, in patients who presented with hip fracture (n = 645), only 7% received a FNB [13]. Moreover, Mittal and Vermani conducted a national survey in the United Kingdom (UK) and found that 74% (n = 230) of the UK EDs contacted had ultrasound access.…”