Department of Nursing and Department of Surgical and Perioperative Science Orthopedics, Umeå University, Umeå, Sweden.
Department of Surgical and Perioperative Science Orthopedics, Umeå University, Umeå, Sweden.
Injury. 2020 Jul;51(7):1634-1641. doi: 10.1016/j.injury.2020.04.013. Epub 2020 Apr 20.
Patients with hip fracture often suffer complications leading to increased mortality and morbidity. Pain management are important, but opioids has many side effects. The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium compared to conventional pain management with opioids among patients with hip fracture, including those with dementia.
PATIENTS & METHODS: In a randomized controlled trial involving patients >70 years with hip fracture (trochanteric and cervical), including those with dementia. Preoperatively, patients (n=236) were consecutively assigned to receive FNB and opioids if required (intervention group, n = 116) or conventional pain management using opioids if required (control group, n = 120). Delirium was set according to different assessments and DSM-IV-TR criteria. Other complications were set by a specialist in geriatric medicine and a trained research nurse according to a predefined protocol.
Most patients, 157 (66%), were women, mean age was 84 (±6.7) years and 109 (46%) patients had dementia disorders. Forty-four patients (38.9%) developed delirium preoperatively in the intervention group compared to 59 (49.2%) patients in the control group (p=0.116). Common postoperative complications were pre- and postoperative delirium, nutritional problems, anaemia, constipation and urinary tract infection with no significant difference between the groups. In the subgroup analysis among patients with dementia, a large proportion developed delirium postoperative (96.3%) and they had a long duration of delirium during hospital stay (5.9 ±1.8), however no difference between the groups.
Despite less preoperative pain and need of opioids, FNB did not reduce the incidence of complications. However, a preoperative FNB may result in less preoperative delirium, but this should be further investigated. As pain treatment, FNB is a good alternative with few documented adverse effects in order to reduce pain and opioids among patients with hip fracture.
髋部骨折患者常发生并发症，导致死亡率和发病率增加。疼痛管理很重要，但阿片类药物有许多副作用。本研究旨在探讨股神经阻滞（FNB）是否可以减少髋部骨折患者（包括痴呆患者）住院期间的并发症，特别是与阿片类药物常规疼痛管理相比，谵妄的发生率。
在一项涉及 >70 岁髋部骨折（转子间和颈）患者的随机对照试验中，包括痴呆患者。术前，患者（n=236）连续分为接受 FNB 和需要时使用阿片类药物（干预组，n=116）或需要时使用阿片类药物常规疼痛管理（对照组，n=120）。谵妄根据不同的评估和 DSM-IV-TR 标准确定。其他并发症由老年医学专家和经过培训的研究护士根据预先制定的方案确定。
大多数患者（66%）为女性，平均年龄为 84（±6.7）岁，109（46%）例患者有痴呆症。干预组术前有 44 例（38.9%）发生谵妄，对照组有 59 例（49.2%）（p=0.116）。常见的术后并发症包括术前和术后谵妄、营养问题、贫血、便秘和尿路感染，两组之间无显著差异。在痴呆患者的亚组分析中，很大一部分患者术后发生谵妄（96.3%），且谵妄持续时间较长（5.9±1.8），但两组之间无差异。
尽管术前疼痛减轻和阿片类药物需求减少，但 FNB 并未降低并发症的发生率。然而，术前 FNB 可能导致术前谵妄减少，但这需要进一步研究。作为疼痛治疗，FNB 是一种替代方法，具有较少的不良影响，以减少髋部骨折患者的疼痛和阿片类药物的使用。
