Randomized Trial of Postoperative Patient-Controlled Analgesia vs. Intramuscular Narcotics in Frail Elderly Men

Egbert, Anne M.; Parks, Leland H.; Short, Lindsay; Burnett, Martin L.

doi:10.1097/00132586-199104000-00027

Cited by 6 publications

(6 citation statements)

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“…One is the high frequency with which pain was associated with the development of delirium; this relationship is not a new one (Lynch et al, 1998) but it is worrying that in a hospital setting, adequate pain control is not consistently achieved. Close attention t o the presence of pain and effective management of the same are not only an important part of good medical care but can also reduce the frequency of in-hospital delirium (Egbert et al, 1990). Another surprising finding was that surgery did not predispose a patient to delirium.…”

Section: Discussionmentioning

confidence: 99%

Incidence of Delirium, Risk Factors, and Long-Term Survival of Elderly Patients Hospitalized in a Medical Specialty Teaching Hospital in Mexico City

Villalpando-Berumen

Pineda-Colorado

Palacios

et al. 2003

Int. Psychogeriatr.

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Background: We determined the incidence, probable risk factors, causes, and long-term survival of delirium in patients hospitalized in a medical specialty teaching hospital in Mexico City. Method: From June to December 1995, 667 elderly patients 60 years and older were hospitalized and assessed within 48 hours, excluding those with delirium at admission, those sedated, on respiratory support, or unable to speak. Results: Twelve percent of the population developed delirium, identified by means of the daily application of the Confusion Assessment Method; its appearance was attributed in 50% to two or more causes, in 10% to an insufficient control of pain, in 7.5% to a preceding surgical event, and in the rest to other causes. Each case was compared randomly with three nonpaired control patients of the same cohort who did not develop delirium. There was a significant increase in the number of cases of delirium in patients older than 75 years (p < .001), those with low schooling (p = .04), those with greater comorbidity (p < .001), those with a hematocrit lower than 30% (relative risk [RR] 2.1, confidence interval [CI] 1.2–4.1), and those with a glucose level greater than 140 mg/dl (RR 2.1, CI 1.2–3.6). Patients with delirium remained hospitalized longer than controls (p = .02). There was no significant difference in the intrahospital mortality of both groups, although during 5 years' follow-up, survivors demonstrated a significant increase in mortality (p = .03) in the group of individuals with delirium during the hospital stay when compared to controls. Conclusion: In this geratric polulation of Mexican patients, delirium incidence was similar to that previously reported in the worldwide literature. Its incidence is associated with longer hospital stay and greater mortality. Age, low level of schooling, greater comorbidity, high glucose levels, poor pain control, and hematocrit lower than 30% were independently associated with a greater incidence of delirium.

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Section: Discussionmentioning

confidence: 99%

Incidence of Delirium, Risk Factors, and Long-Term Survival of Elderly Patients Hospitalized in a Medical Specialty Teaching Hospital in Mexico City

Villalpando-Berumen

Pineda-Colorado

Palacios

et al. 2003

Int. Psychogeriatr.

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“…With the increased use of patient‐controlled analgesia (PCA) pumps in hospitals, the number of IM injections given for pain control is declining ( Mackintosh & Bowles 1997). Despite evidence ( Egbert et al . 1990 , Gould et al .…”

Section: Intramuscular Injection Techniquesmentioning

confidence: 99%

Drawing up and administering intramuscular injections: a review of the literature

Rodger

King

2000

Journal of Advanced Nursing

145

126

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Drawing up and administering intramuscular injections: a review of the literature Intramuscular (IM) injections have been an integral part of drug administration in nursing practice for almost half a century. However, there are some conflicting practices which warrant investigation to determine their effectiveness in this aspect of patient care. To this end, this paper presents the results of a literature review which was carried out in order to establish current understanding of present day knowledge, procedures and guidelines for the administration of IM injections. Areas addressed within this review include injection sites used, injuries associated with IM injections, issues surrounding needle selection and volume administered through IM injections, injection techniques and nursing skills associated with IM injections. Synthesis of the research reviewed allows the development of research-based guidelines for this skill. These guidelines offer a framework for nurses who wish to provide practice in line with current research into the process of drawing up and administration of intramuscular injections.

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“…However, the latter may be a modifiable factor through exercise training 10 . These processes slow the rate of drug absorption from intramuscular sites and thereby delay the onset and/or prolong drug action by a depot effect 11 …”

Section: Systemic Absorptionmentioning

confidence: 99%

Drug Absorption in the Management of Congestive Heart Failure: Loop Diuretics

Sica

2003

Congestive Heart Failure

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Congestive heart failure is a disease state distinguished by the regular presence of both renal and hepatic abnormalities in drug handling. One such abnormality involves flaws in the process of drug absorption. In most instances, congestive heart failure-related abnormalities in drug absorption are of inconsequential significance. However, this is not the case with loop diuretics. Loop diuretic action ordinarily tracks the rate and extent of absorption if a sufficient amount of diuretic has been given to exceed the threshold for diuretic effect. In congestive heart failure, both the rate and absolute amount of loop diuretic absorbed can be reduced as a function of the heart failure state itself. In this setting, drug dissolution characteristics can assume added significance. Furosemide is the loop diuretic with the widest intra- and interpatient variability of absorption. Alternatively, the loop diuretic torsemide is rapidly and fairly completely absorbed independent of the heart failure state. This pattern of absorption establishes it as the preferred loop diuretic in the otherwise diuretic-resistant heart failure patient. However, the exact role of torsemide in the outpatient management of congestive heart failure remains to be determined.

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Randomized Trial of Postoperative Patient-Controlled Analgesia vs. Intramuscular Narcotics in Frail Elderly Men

Cited by 6 publications

References 0 publications

Incidence of Delirium, Risk Factors, and Long-Term Survival of Elderly Patients Hospitalized in a Medical Specialty Teaching Hospital in Mexico City

Incidence of Delirium, Risk Factors, and Long-Term Survival of Elderly Patients Hospitalized in a Medical Specialty Teaching Hospital in Mexico City

Drawing up and administering intramuscular injections: a review of the literature

Drug Absorption in the Management of Congestive Heart Failure: Loop Diuretics

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