Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study

Abstract

The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p \ 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p \ 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score [ 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p \ 0.05).

Oral vs. IV paracetamol for pain control in patients with femur fracture in the emergency department: a practical randomized controlled trial

“…Pain is commonly associated with FF in patients accessing the ED for this condition. Literature data show that FF occurs especially in the female population aged >80 years [2,10,[21][22][23]. A systematic review of 72 studies carried out in 63 dif-ferent countries revealed that Italy is among the countries with the highest incidence of hip and FF with an incidence higher than 300/100.000 inhabitants/year for women and higher than 150/100.000 inhabitants/year for men [23][24][25].…”

Use of electronic health record data to examine administrations of pro re nata analgesics during hip fracture post‐acute care

“…[9][10][11][12][13][14][15][16][17][18] Several studies have focused on the hospitalization rather than the post-acute care period or excluded individuals receiving short-term institutional postacute care (i.e., in SNFs) who represent the majority of hip fracture cases. 9,10,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] Clinical guidance recommends using multimodal analgesia to manage pain, but limited evidence exists on which combinations of analgesics are safest and most effective for older adults receiving post-acute care following hip fracture. 2,8,36,[38][39][40] To overcome these challenges, we leveraged electronic health record (EHR) medication orders and medication administration records (MARs) aggregated from nearly 700 U.S. SNFs to describe patterns of short-term analgesic prescribing and use following a hip fracture.…”

“…Methodological challenges related to ascertaining medication use in SNFs are a likely reason for the paucity of evidence on pain management during post‐acute care for hip fracture 9–18 . Several studies have focused on the hospitalization rather than the post‐acute care period or excluded individuals receiving short‐term institutional post‐acute care (i.e., in SNFs) who represent the majority of hip fracture cases 9,10,19–37 . Clinical guidance recommends using multimodal analgesia to manage pain, but limited evidence exists on which combinations of analgesics are safest and most effective for older adults receiving post‐acute care following hip fracture 2,8,36,38–40 …”