scholarly journals Intrathecal morphine is associated with less delirium following hip fracture surgery; a register study

2019 ◽  
Author(s):  
Mark Vincent Koning ◽  
Max P.L. van der Sijp ◽  
Robert Jan Stolker ◽  
Arthur H.P. Niggebrugge
Keyword(s):  
Multivariate Analysis ◽  
Spinal Anesthesia ◽  
Intrathecal Morphine ◽  
Group Versus ◽  
Proximal Femoral Fracture ◽  
Contributing Factors ◽  
Randomised Study ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Fracture Surgery

Abstract Purpose Delirium is a common complication after proximal femoral fracture surgery and contributing factors are pain and opioid consumption. The administration of intrathecal morphine may decrease these factors postoperatively and potentially decrease delirium. The aim of this research is to study the association between the use of intrathecal morphine and the occurrence of delirium. Methods A retrospective analysis of a register kept in a non-academic hospital in the Netherlands was performed. The register contained data of all patients with proximal femur fractures that were surgically treated with osteosynthesis or prothesis. Patients receiving spinal anesthesia with local anesthetics (SA-group) were compared with patients receiving spinal anesthesia with the addition of intrathecal morphine (SIM-group). The administration of either SA or SIM was based on the preference of the anesthesiologist. Primary outcome was the incidence of delirium, as defined by the DSM-V classification. Both univariate and multivariate analysis were performed. Results The SA-group consisted of 451 patients and 34 patients were included in the SIM-group. Delirium occurred in 19.7% in the SA-group versus 5.9% in the SIM-group (p=0.046). This association remained significant after correction in multivariate analysis (OR of delirium in the SA group, 95% CI: 1.062 – 21.006, p=0.041). Additionally, multivariate analysis revealed that age, gender, preoperative cognitive impairment and fracture treatment (osteosynthesis or prosthesis) were independently associated with delirium . Conclusion This retrospective study found an independent association between the use of intrathecal morphine and a lower incidence of delirium. This clinically relevant decrease in delirium should be studied in a prospective randomised study.

scholarly journals Intrathecal Morphine Is Associated with Less Delirium Following Hip Fracture Surgery: A Register Study

2020 ◽  
Vol 10 (4) ◽  
Author(s):  
Mark Vincent Koning ◽  
Max van der Sijp ◽  
Robert Jan Stolker ◽  
Arthur Niggebrugge
Keyword(s):  
Multivariate Analysis ◽  
Spinal Anesthesia ◽  
Intrathecal Morphine ◽  
Randomized Study ◽  
Group Versus ◽  
Proximal Femoral Fracture ◽  
Contributing Factors ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Fracture Surgery

Background: Delirium is a common complication after proximal femoral fracture surgery, with pain and opioid consumption as the contributing factors. The administration of intrathecal morphine may decrease these factors postoperatively and potentially reduce delirium. Objectives: This research aimed to study the association between the use of intrathecal morphine and the occurrence of delirium. Methods: A retrospective analysis of a prospective register kept in a non-academic hospital in the Netherlands was performed. The register contained data of all patients with proximal femur fractures that were surgically treated with osteosynthesis or prosthesis. Patients receiving spinal anesthesia (SA group) were compared with patients receiving spinal anesthesia with the addition of intrathecal morphine (SIM group). The administration of either SA or SIM was based on the preference of the anesthesiologist. The primary outcome was the incidence of delirium, as defined by the DSM-V classification. The follow-up lasted until hospital discharge. Both univariate and multivariate analyses were performed. Results: The SA group consisted of 451 patients, and the SIM group included 34 patients. Delirium occurred in 19.7% in the SA group versus 5.9% in the SIM group (P = 0.046). This association remained significant after correction in multivariate analysis (OR of delirium in the SA group, 95% CI: 1.062 - 21.006, P = 0.041). Additionally, multivariate analysis revealed that age, gender, preoperative cognitive impairment, and fracture treatment (osteosynthesis or prosthesis) were independently associated with delirium. Conclusions: This retrospective study found an independent association between the use of intrathecal morphine and a lower incidence of delirium. This clinically relevant decrease in delirium should be studied in a prospective randomized study.

scholarly journals Case Report: 100-year-old COVID-positive Hip Fracture Patient for Hemiarthroplasty Under Spinal Anesthesia

2020 ◽  
Vol 6 ◽  
pp. 233372142095676 ◽  
Author(s):  
Jonathan C. Beathe ◽  
Stavros G. Memtsoudis
Keyword(s):  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Surgical Intervention ◽  
Early Mobilization ◽  
Hip Fracture Surgery ◽  
Global Pandemic ◽  
Unique Experience ◽  
Novel Coronavirus ◽  
Fracture Surgery ◽  
Early Surgical Intervention

Elderly patients undergoing hip fracture surgery represent a myriad of perioperative challenges and risks. The arrival of the global pandemic of novel coronavirus disease 2019 (COVID-19) adds an unprecedented challenge to the management of hip fracture patients. We describe the unique experience and favorable outcome of a 100-year-old COVID-positive hip fracture patient that underwent spinal anesthesia for hemiarthroplasty and subsequent hydroxychloroquine (HCQ) therapy. Multiple factors of varying known benefit may have contributed to our outcome, including preoperative medical consultation and assessment, early surgical intervention, regional anesthesia with little to no sedation, early mobilization and HCQ therapy.

The influence of anesthetic techniques on postoperative cognitive function in elderly patients undergoing hip fracture surgery: General vs spinal anesthesia

Injury ◽  
2018 ◽  
Vol 49 (12) ◽  
pp. 2221-2226 ◽  
Author(s):  
Petros Tzimas ◽  
Evangelia Samara ◽  
Anastasios Petrou ◽  
Anastasios Korompilias ◽  
Athanasios Chalkias ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Cognitive Function ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Anesthetic Techniques ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

Haemodynamic effects of spinal anesthesia in elderly patients undergoing hip fracture surgery

2010 ◽  
Vol 27 ◽  
pp. 241-242
Author(s):  
A. Messina ◽  
L. Frassanito ◽  
A. Catalano ◽  
A. Castellana ◽  
S. Santoprete
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Haemodynamic Effects ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Comparison of two doses of hypobaric bupivacaine in unilateral spinal anesthesia for hip fracture surgery: 5 mg versus 7.5 mg

2017 ◽  
Vol 28 ◽  
Author(s):  
Mohamed Kahloul ◽  
Mohamed Said Nakhli ◽  
Amine Chouchene ◽  
Nidhal Chebbi ◽  
Salah Mhamdi ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Spinal Anesthesia ◽  
Hip Fracture Surgery ◽  
Unilateral Spinal Anesthesia ◽  
Fracture Surgery

Safety and effectiveness of coadministration of intrathecal sufentanil and morphine in hyperbaric bupivacaine-based spinal anesthesia for cesarean section

2018 ◽  
Vol 5 (4) ◽  
pp. 197 ◽  
Author(s):  
Gaetano Draisci, MD ◽  
Luciano Frassanito, MD ◽  
Raffaella Pinto, MD ◽  
Bruno Zanfini, MD ◽  
Gabriella Ferrandina, MD ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Spinal Anesthesia ◽  
Intrathecal Morphine ◽  
Controlled Trial ◽  
Group Versus ◽  
Elective Cesarean Section ◽  
Single Administration ◽  
Hyperbaric Bupivacaine ◽  
Double Blind ◽  
Significant Group

Subarachnoid block is a widely used technique for cesarean section. Opioids adding to the local anesthetics can improve its quality. In this prospective, randomized, double blind, controlled trial, we compared the effects of coadministration of intrathecal sufentanil and morphine with intrathecal sufentanil and a single administration of subcutaneous morphine. Sixty-four pregnant women scheduled for elective cesarean section under spinal anesthesia were assigned to two groups according to the way of administration of morphine: intrathecal sufentanil (5 μg) plus intrathecal morphine (150 μg) (ITM group), and intrathecal sufentanil (5 μg) plus single administration of 10 mg subcutaneous morphine (SCM group). In both groups, the local anesthetic used was hyperbaric bupivacaine 0.5 percent (10 mg). Both groups received 1 g acetaminophen every 6 hours. In the postoperative period, pain was recorded on a 0-100 visual analog scale (VAS) and intravenous tramadol (100 mg) was administered if VAS score was >40 mm. Collateral effects, such us nausea, itching, respiratory depression, and sedation were assessed. VAS scores at rest and on coughing were significantly higher in the SCM group than in the ITM group between 3 and 24 hours. The mean titrated dose of tramadol consumed was also significantly greater in the SCM group than in the ITM group (p < 0.05). The time to first administration of tramadol was lower in the SCM group versus the ITM group (p < 0.05). The incidence of nausea was significantly lower in the SCM group than in the ITM group (p < 0.05). There was no significant group difference in the incidence of pruritus (p > 0.05). In conclusion, coadministration of sufentanil and morphine into the subarachnoid space was effective and provided longer pain relief than intrathecal sufentanil plus a single injection of subcutaneous morphine, despite a higher incidence of side effects such as nausea and vomiting.

Blood transfusion rates and predictors following geriatric hip fracture surgery

2020 ◽  
pp. 112070001989787 ◽  
Author(s):  
Armin Arshi ◽  
Wilson C Lai ◽  
Brenda C Iglesias ◽  
Edward J McPherson ◽  
Erik N Zeegen ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Blood Transfusion ◽  
Hip Fractures ◽  
Improvement Program ◽  
Hip Fracture Surgery ◽  
Femur Fractures ◽  
Postoperative Blood Transfusion ◽  
Geriatric Hip Fracture ◽  
Fracture Surgery

Background: Postoperative blood product transfusions in elderly hip fracture patients cause concern for morbidity and mortality. The purpose of this study was to identify predictors and short-term sequelae of postoperative transfusion following geriatric hip fracture surgery. Methods: We queried the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) to identify geriatric (⩾65 years) patients who sustained operative femoral neck, intertrochanteric, and subtrochanteric hip fractures in 2016. Multivariate regression was used to determine risk-adjusted odds ratios (OR) of associated perioperative risk factors and sequelae of postoperative transfusion. Results: In total, 8416 geriatric hip fracture patients were identified of whom 28.3% had documented postoperative transfusion. In multivariate analysis, age (OR 1.03 [1.02–1.04], p < 0.001), preoperative anaemia (OR 4.69 [3.99–5.52], p = 0.001), female sex (OR 1.61 [1.39–1.87], p < 0.001), lower BMI (OR 0.97 [0.96–0.98], p < 0.001), American Society of Anesthesiologists (ASA) classification (OR 1.14 [1.01–1.27], p = 0.031), COPD (OR 1.30 [1.06–1.59], p = 0.011), hypertension (OR 1.17 [1.01–1.35], p = 0.038), increased OR time (OR 1.02 [1.01–1.03], p < 0.001), and intertrochanteric (OR 2.99 [2.57–3.49], p < 0.001) and subtrochanteric femur fractures (OR 5.07 [3.84–6.69], p < 0.001) were independent risk factors for receiving postoperative blood transfusion. Patients with postoperative transfusion had a significantly higher risk-adjusted 30-day mortality (8.4% vs. 6.4%, OR 1.29 [1.02–1.64], p = 0.035), hospital readmission rate (9.4% vs. 7.7%, OR 1.27 [1.04–1.55], p = 0.018), and total hospital LOS (7.3 vs. 6.3 days, p < 0.001). Conclusions: Postoperative transfusion is a common occurrence in geriatric fragility hip fractures with multiple risk factors. Careful preoperative planning and multidisciplinary management efforts are warranted to reduce use of postoperative transfusions.

scholarly journals Effects of Anesthesia Techniques on Outcomes after Hip Fracture Surgery in Elderly Patients: A Prospective, Randomized, Controlled Trial

2020 ◽  
Vol 9 (6) ◽  
pp. 1605
Author(s):  
Seokyung Shin ◽  
Seung Hyun Kim ◽  
Kwan Kyu Park ◽  
Seon Ju Kim ◽  
Jae Chan Bae ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Spinal Anesthesia ◽  
Troponin T ◽  
Controlled Trial ◽  
High Mobility ◽  
Secondary Outcome ◽  
Hip Fracture Surgery ◽  
Balanced Anesthesia ◽  
Fracture Surgery

The superiority of distinct anesthesia methods for geriatric hip fracture surgery remains unclear. We evaluated high mobility group box-1 (HMGB1) and interleukin-6 (IL-6) with three different anesthesia methods in elderly patients undergoing hip fracture surgery. Routine blood test findings, postoperative morbidity, and mortality were assessed as secondary outcome. In total, 176 patients were randomized into desflurane (n = 60), propofol (n = 58), or spinal groups (n = 58) that received desflurane-based balanced anesthesia, propofol-based total intravenous anesthesia (TIVA), or spinal anesthesia, respectively. The spinal group required less intraoperative vasopressors (p < 0.001) and fluids (p = 0.006). No significant differences in HMGB1 (pgroup×time = 0.863) or IL-6 (pgroup×time = 0.575) levels were noted at baseline, postoperative day (POD) 1, or POD2. Hemoglobin, albumin, creatinine, total lymphocyte count, potassium, troponin T, and C-reactive protein were comparable among groups at all time-points. No significant differences in postoperative hospital stay, intensive care unit (ICU) stay, and ventilator use among groups were observed. Postoperative pulmonary, cardiac, and neurologic complications; and in-hospital, 30-day, and 90-day mortality were not significantly different among groups (p = 0.974). In conclusion, HMGB1 and IL-6, and all secondary outcomes, were not significantly different between desflurane anesthesia, propofol TIVA, and spinal anesthesia.

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