Unneby Anna, Svensson Olle, Gustafson Yngve, Olofsson Birgitta
Department of Nursing and Department of Surgical and Perioperative Science Orthopaedics, Umeå University, SE-90187, Umeå, Sweden.
Department of Surgical and Perioperative Science Orthopaedics, Umeå University, Umeå, Sweden.
Injury. 2017 Jul;48(7):1542-1549. doi: 10.1016/j.injury.2017.04.043. Epub 2017 Apr 24.
The number of elderly people with hip fracture and dementia is increasing, and many of these patients suffer from pain. Opioids are difficult to adjust and side effects are common, especially with increased age and among patients with dementia. Preoperative femoral nerve block is an alternative pain treatment.
To investigate whether preoperative femoral nerve block reduced acute pain and opioid use after hip fracture among elderly patients, including those with dementia.
In this randomised controlled trial involving patients aged ≥70years with hip fracture (trochanteric and cervical), including those with dementia, we compared femoral nerve block with conventional pain management, with opioid use if required. The primary outcome was preoperative pain, measured at five timepoints using a visual analogue scale (VAS). Preoperative opioid consumption was also registered.
The study sample comprised 266 patients admitted consecutively to the Orthopaedic Ward. The mean age was 84.1 (±6.9)years, 64% of participants were women, 44% lived in residential care facilities, and 120 (45.1%) had dementia diagnoses. Patients receiving femoral nerve block had significantly lower self-rated pain scores from baseline to 12h after admission than did controls. Self-rated and proxy VAS pain scores decreased significantly in these patients from baseline to 12h compared with controls (p<0.001 and p=0.003, respectively). Patients receiving femoral nerve block required less opioids than did controls, overall (2.3±4.0 vs. 5.7±5.2mg, p<0.001) and in the subgroup with dementia (2.1±3.3 vs. 5.8±5.0mg, p<0.001).
Patients with hip fracture, including those with dementia, who received femoral nerve block had lower pain scores and required less opioids before surgery compared with those receiving conventional pain management. Femoral nerve block seems to be a feasible pain treatment for elderly people, including those with dementia.
髋部骨折且患有痴呆症的老年人数量正在增加，这些患者中有许多人遭受疼痛折磨。阿片类药物难以调整剂量且副作用常见，尤其是在年龄增长以及痴呆症患者中。术前股神经阻滞是一种替代性的疼痛治疗方法。
研究术前股神经阻滞是否能减轻老年髋部骨折患者（包括患有痴呆症的患者）术后的急性疼痛并减少阿片类药物的使用。
在这项随机对照试验中，纳入了年龄≥70岁的髋部骨折（转子间骨折和股骨颈骨折）患者，包括患有痴呆症的患者，我们将股神经阻滞与传统疼痛管理进行比较，必要时使用阿片类药物。主要结局是术前疼痛，使用视觉模拟量表（VAS）在五个时间点进行测量。术前阿片类药物的消耗量也进行了记录。
研究样本包括266名连续入住骨科病房的患者。平均年龄为84.1（±6.9）岁，64%的参与者为女性，44%居住在养老院，120名（45.1%）有痴呆症诊断。接受股神经阻滞的患者从入院基线至入院后12小时的自评疼痛评分显著低于对照组。与对照组相比，这些患者从基线至12小时的自评和代理VAS疼痛评分显著降低（分别为p<0.001和p = 0.003）。总体而言，接受股神经阻滞的患者比对照组需要更少的阿片类药物（2.3±4.0 vs. 5.7±5.2mg，p<0.001），在患有痴呆症的亚组中也是如此（2.1±3.3 vs. 5.8±5.0mg，p<0.001）。
与接受传统疼痛管理的患者相比，接受股神经阻滞的髋部骨折患者（包括患有痴呆症的患者）术前疼痛评分更低，所需阿片类药物更少。股神经阻滞似乎是包括患有痴呆症的老年人在内的可行的疼痛治疗方法。
