Tremblay Alexandra, Pelet Stéphane, Belzile Étienne, Morency Chantal, Dion Norbert, Linsotan Sandrine, Tapp Diane, Benhamed Axel, Gagnon Marc-Aurèle, Severino Fabian, Bérubé Mélanie
Faculty of Nursing (A.T., S.L., D.T., F.S., M.B.), Université Laval, Québec City, Quebec, Canada; CHU de Québec-Université Laval Research Centre (A.T., S.L., M-A.G., F.S., M.B.), Population Health and Optimal Practices Research Unit Research Unit (Trauma-Emergency-Critical Care Medicine), Québec City, Quebec, Canada.
Department of Surgery (S.P., E.B., N.D.), Division of Orthopedic Surgery, CHU de Quebec-Université Laval, Québec City, Quebec, Canada; Faculty of Medicine (S.P., E.B., C.M., N.D., A.B.), Université Laval, Québec City, Quebec, Canada.
J Pain Symptom Manage. 2025 Aug;70(2):149-159.e6. doi: 10.1016/j.jpainsymman.2025.04.012. Epub 2025 May 6.
Adequate pain management in frail hip fracture patients receiving nonoperative treatment has been identified as an important issue. Palliative care could be an option to consider to ensure a comfortable end of life for these patients.
This study aimed to describe pain relief in frail patients admitted to palliative care following a hip fracture, and the pain management strategies used among them.
This descriptive monocentric observational study included a retrospective phase, based on a review of medical records, and a prospective phase, by direct observation of patients. Data collection took place within the first five days following admission to palliative care. Pain was assessed with the ALGOPLUS scale. Data on pharmacological and nonpharmacological pain management strategies were collected from medical records.
A total of 61 patients with a mean age of 87 years (±7) and severe frailty were included. The proportion of patients with pain at rest ranged from 30% on day 1 to 10% on day 5, and from 71% to 32% during mobilization. The mean oral morphine equivalent daily dose administered ranged from 13.1 mg (±10.7) to 21.9 mg (±16.2). On average, 75% of patients received co-analgesics, and nonpharmacological strategies were applied in 33% of them over the five-day of data collection period.
Pain remains an issue in frail patients with a nonoperated hip fracture, despite the provision of palliative care. Optimizing pain management, particularly ahead of mobilization, remains a crucial and underexplored area to address for this population.
在接受非手术治疗的髋部骨折体弱患者中，充分的疼痛管理已被视为一个重要问题。姑息治疗可能是一种可考虑的选择，以确保这些患者有一个舒适的生命末期。
本研究旨在描述髋部骨折后入住姑息治疗病房的体弱患者的疼痛缓解情况，以及他们所采用的疼痛管理策略。
这项描述性单中心观察性研究包括一个回顾性阶段（基于病历审查）和一个前瞻性阶段（通过直接观察患者）。数据收集在入住姑息治疗病房后的头五天内进行。采用ALGOPLUS量表评估疼痛。从病历中收集有关药物和非药物疼痛管理策略的数据。
共纳入61例平均年龄87岁（±7岁）且严重体弱的患者。静息时疼痛患者的比例从第1天的30%降至第5天的10%，活动时从71%降至32%。平均每日口服吗啡等效剂量从13.1毫克（±10.7）至21.9毫克（±16.2）不等。在数据收集的五天期间，平均75%的患者接受了辅助镇痛药，33%的患者采用了非药物策略。
尽管提供了姑息治疗，但疼痛仍是未接受手术治疗的髋部骨折体弱患者的一个问题。优化疼痛管理，尤其是在活动前，对于这一人群而言仍是一个关键且未得到充分探索的领域。
