Agarwal Nikhil, MacLullich Alasdair M J, Clement Nick D
Division of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, Edinburgh, UK.
Division of Geriatric Medicine, Royal Infirmary of Edinburgh, Edinburgh, UK.
Bone Jt Open. 2025 Jan 10;6(1):53-61. doi: 10.1302/2633-1462.61.BJO-2024-0076.R1.
The primary aim of this study is to compare mobility status of patients receiving oral oxycodone with those receiving subcutaneous alfentanil as analgesic methods prior to mobilization to help physiotherapy compliance after hip fracture surgery. The secondary aims are to assess postoperative pain, health-related quality of life, in-hospital length of stay, total use of analgesia over postoperative days 1 and 2 (POD 1 and POD 2), complication rates within 30 days, and 30-day mortality rates.
A single-centre, prospective cohort study of 64 patients will be undertaken. Patients undergoing surgery for femoral neck fractures at the study centre will be recruited. Patients with a hip fracture meeting the inclusion/exclusion criteria will be enrolled on admission. Patients who have been administered oral oxycodone will be compared to those prescribed alfentanil for pain prior to mobilization with physiotherapists on POD 1 and POD 2. Which drug a patient receives is reliant of the prescriptions given by the medical team, and in current practice this varies at approximately 50:50. Mobilization will be defined as the ability to stand on and weightbear both feet with or without assistance.
Visual analogue scale pain scores, mobility status, and total analgesia use will be assessed on POD 1 and POD 2. EuroQol five-dimension health questionnaire scores, complication rates, and mortality rates will be assessed up to 30 days following surgery (POD 1, 2, 7, and 30).
This study will help to build a wider protocol aiming to improve early mobilization after hip fracture surgery. The results of this study will provide pain scores and mobility status which will either support use of subcutaneous alfentanil as the standard analgesic modality prior to physiotherapy sessions, or highlight its limitations compared to the standard oral oxycodone. Secondary outcomes will also help to assess if early mobilization improves outcomes compared to delayed mobilization.
本研究的主要目的是比较口服羟考酮的患者与接受皮下注射阿芬太尼的患者在活动前作为镇痛方法的活动状态，以帮助提高髋部骨折手术后的物理治疗依从性。次要目的是评估术后疼痛、健康相关生活质量、住院时间、术后第1天和第2天（POD 1和POD 2）的镇痛总用量、30天内的并发症发生率和30天死亡率。
将进行一项针对64名患者的单中心前瞻性队列研究。招募在研究中心接受股骨颈骨折手术的患者。符合纳入/排除标准的髋部骨折患者将在入院时登记。在POD 1和POD 2与物理治疗师一起活动前，将接受口服羟考酮的患者与开具阿芬太尼用于止痛的患者进行比较。患者接受哪种药物取决于医疗团队的处方，在目前的实践中，这两种药物的使用比例约为50:50。活动将定义为在有或没有帮助的情况下双脚站立并负重的能力。
将在POD 1和POD 2评估视觉模拟量表疼痛评分、活动状态和镇痛总用量。将在术后30天（POD 1、2、7和30）评估欧洲五维健康问卷评分、并发症发生率和死亡率。
本研究将有助于建立一个更广泛的方案，旨在改善髋部骨折手术后的早期活动。本研究结果将提供疼痛评分和活动状态，这将支持使用皮下注射阿芬太尼作为物理治疗前的标准镇痛方式，或突出其与标准口服羟考酮相比的局限性。次要结果还将有助于评估与延迟活动相比，早期活动是否能改善预后。
