scholarly journals Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review

Pain medicine ◽  
2020 ◽  
Vol 4 (4) ◽  
pp. 42-49
Author(s):  
Anastasiia Romanenko ◽  
Юрій Кучин ◽  
Катерина Бєлка ◽  
Ігор Токар
Keyword(s):  
Hip Fracture ◽  
Pain Management ◽  
Elderly Patients ◽  
Femoral Fracture ◽  
Adverse Drug Events ◽  
Perioperative Period ◽  
The Elderly ◽  
Proximal Femoral Fracture ◽  
Nerve Blocks ◽  
Number Of Patients

The purpose of this article is to compare different methods of analgesia during perioperative period in elderly patients with а proximal femoral fracture. The incidence of hip fracture is high and also rises with the age, for example, In Great Britain, number of patients with a hip fracture will be approximately 100 000 in 2033, and it’s also associated with significant healthcare financing. Nevertheless, effective pain management is a big challenge for clinicians because of considerable problems in geriatric patients, including age, physiological changes in the elderly, preexisting comorbidities, cognitive impairment, high risk of delirium, problems with rehabilitation and probability of an independent life [12].   Opioids are still the main option for hip fracture pain management, despite differences in pharmacokinetics and pharmacodynamics in elderly patients, which are correlated with high frequency of side effects. Opioid-related adverse drug events are associated with worse patient outcomes such as morbidity, mortality and length of stay increase. Therefore, peripheral nerve blocks as part of multimodal analgesic technique can provide more effective pain control after hip fracture. Comprehensive literature searches focus on the use of peripheral nerves blocks as preoperative analgesia, as postoperative analgesia or as a supplement to general anesthesia for hip fracture surgery.

scholarly journals Regional Nerve Block Decreases the Incidence of Postoperative Delirium in Elderly Hip Fracture

2021 ◽  
Vol 10 (16) ◽  
pp. 3586
Author(s):  
Eic Ju Lim ◽  
Won Uk Koh ◽  
Hyungtae Kim ◽  
Ha-Jung Kim ◽  
Hyun-Chul Shon ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Pain Score ◽  
Postoperative Delirium ◽  
Standard Procedure ◽  
Proximal Femoral Fracture ◽  
Early Postoperative Period ◽  
Control Group ◽  
Nerve Blocks ◽  
Significant Difference

Postoperative delirium is common in elderly patients with hip fracture. Pain is a major risk factor for delirium, and regional nerve blocks (RNBs) effectively control pain in hip fractures. This study aimed to evaluate the effect of RNB on delirium after hip surgery in elderly patients. This retrospective comparative study was performed in a single institution, and the data were collected from medical records between March 2018 and April 2021. Patients aged ≥60 years who underwent proximal femoral fracture surgery were included, while those with previous psychiatric illness and cognitive impairment were excluded. Two hundred and fifty-two patients were enrolled and divided into an RNB or a control group according to RNB use. Delirium was assessed as the primary outcome and postoperative pain score, pain medication consumption, and rehabilitation assessment as the secondary outcomes. Between the RNB (n = 129) and control groups (n = 123), there was no significant difference in the baseline characteristics. The overall incidence of delirium was 21%; the rate was lower in the RNB group than in the control group (15 vs. 27%, respectively, p = 0.027). The average pain score at 6 h postoperatively was lower in the RNB group than in the control group (2.8 ± 1.5 vs. 3.3 ± 1.6, respectively, p = 0.030). There was no significant difference in the pain score at 12, 24, and 48 h postoperatively, amount of opioids consumed for 2 postoperative days, and time from injury to wheelchair ambulation. We recommend RNB as a standard procedure for elderly patients with hip fracture due to lower delirium incidence and more effective analgesia in the early postoperative period.

scholarly journals Comminuted Patella Fracture in Elderly Patients: A Systematic Review and Case Report

2017 ◽  
Vol 8 (3) ◽  
pp. 135-144 ◽  
Author(s):  
Brent Matthews ◽  
Kaushik Hazratwala ◽  
Sergio Barroso-Rosa
Keyword(s):  
Case Report ◽  
Elderly Patients ◽  
Treatment Options ◽  
The Elderly ◽  
Fracture Pattern ◽  
Patella Fracture ◽  
Level Of Evidence ◽  
Fixation Failure ◽  
Number Of Patients ◽  
Mesh Augmentation

Objectives: To review comminuted patella fracture in the elderly patients and examine the surgical options to avoid complications such as fixation failure and poor functional outcome. To provide an example of mesh augmentation in comminuted patella fracture in the elderly patients. Data Sources: A literature review was conducted by the authors independently using Ovid, Medline, Cochrane, PubMed, and Clinical Key in English. We aimed to review data on patients older than 65 with comminuted patella fracture. Search conducted between July and December 2015. Study Selection: Search terms included patella fracture, elderly, and fixation failure. Abstracts were included if they were a case report, cohort series, or randomized control trial. Further inclusion criteria were that they were available in full text and included patient age(s), operative details, follow-up, and outcome discussion. Data Extraction: Each study was assessed according to its level of evidence, number of patients, age of patients, fracture patterns described, complications of treatment, and results summarized. Data Synthesis: Paucity of data and heterogeneity of studies limited statistical analysis. Data are presented as a review table with the key points summarized. Conclusion: In patella fracture, age >65 years and comminuted fracture pattern are predictors of increased fixation failure and postoperative stiffness, warranting special consideration. There is a trend toward improved functional outcomes when augmented fixation using mesh or plates is used in this group. Further level 1 studies are required to compare and validate new treatment options and compared them to standard surgical technique of tension band wire construct.

scholarly journals The Relationship between Smoking and Sublingual Varices in the Elderly

2021 ◽  
Vol 36 (4) ◽  
pp. e288-e288
Author(s):  
Niusha Barzideh ◽  
Arezoo Alaee ◽  
Arash Azizi
Keyword(s):  
Older Adults ◽  
Cigarette Smoking ◽  
Elderly Patients ◽  
Varicose Veins ◽  
The Elderly ◽  
Control Group ◽  
Case Group ◽  
Chi Square ◽  
Number Of Patients ◽  
And Control

Objectives: We investigated the existence of any connection between smoking and sublingual varices (SLV) in the older population. Methods: This case-control study was conducted in 2019 on adults > 65 years old at Kahrizak Charity Nursing Home, Alborz, Iran. We conducted clinical examination and inspection of 222 elderly patients. Both the case group and control group contained the same number of patients (n = 111). SLV were classified as grade 0 (few or none visible) and grade 1 (moderate or severe). The case group included patients with SLV and the control group consisted of those older adults without SLV and who were matched with the case group based on age, gender, blood pressure, denture wearing, and varicose veins in their legs. Cigarette smoking habits were investigated in both groups. Smokers were considered those who smoked at least one cigarette per day for more than six months. Chi-square and odds ratio (OR) were used to statistically analyze the exposure of participants to smoking in both groups. Results: Among 222 participants, 21.6% and 5.4% were smokers in the case and control groups, respectively. The results of our data analysis revealed that SLV were significantly associated with smoking (p < 0.001, OR = 4). Conclusions: Elderly patients with SLV are more likely to be cigarette smokers. Therefore, cigarette smoking cessation programs are recommended for older adults in society.

scholarly journals Incidence and risk factors of postoperative delirium in the elderly patients with hip fracture

2018 ◽  
Vol 13 (1) ◽  
Author(s):  
Chen-guang Wang ◽  
Ya-fei Qin ◽  
Xin Wan ◽  
Li-cheng Song ◽  
Zhi-jun Li ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hip Fracture ◽  
Elderly Patients ◽  
Postoperative Delirium ◽  
The Elderly

scholarly journals 13 Amending Admission Protocol to Reduce Proton Pump Inhibitor-Induced Hyponatraemia on A Specialist Hip Fracture Unit

2020 ◽  
Vol 49 (Supplement_1) ◽  
pp. i1-i8
Author(s):  
R Darnell ◽  
B Clements ◽  
E Reeve ◽  
N Singh
Keyword(s):  
Hip Fracture ◽  
Proton Pump Inhibitor ◽  
Elderly Patients ◽  
Proton Pump ◽  
Side Effect ◽  
Sodium Concentration ◽  
Improvement Project ◽  
Number Of Patients ◽  
Group A ◽  
Group B

Abstract Introduction Hyponatraemia is a common electrolyte disturbance amongst elderly patients. Defined as a sodium concentration below 135 mmol/L, the BNF cites hyponatraemia as a ‘rare’ side effect of Omeprazole, a common proton pump inhibitor (PPI). In elderly patients, hyponatraemia can have significant morbidity. On our Hip Fracture Unit (HFU) at St Helier Hospital, all patients are commenced on Omeprazole on admission. We conducted a quality improvement project to reduce the incidence of PPI-induced hyponatraemia by altering standard protocol from Omeprazole to Ranitidine. Methods Phase 1: Retrospective analysis identifying incidence of PPI-induced hyponatraemia, defined as sodium concentration below 133mmol/L on two consecutive readings and resolving on switching to Ranitidine (Group A: n=86). Phase 2: Identifying incidence of hyponatraemia following administration of Ranitidine from admission (Group B: n=62). Exclusion criteria: Patients already on gastric protection or hyponatraemic on presentation. Chi squared analysis to establish statistical significance for risk of hyponatraemia associated with omeprazole. Results Total number of patients was 148. Age range 60-101 years (median 82 years). Incidence of PPI-induced hyponatraemia in Group A was 10.5% (9 cases). All resolved on switching to ranitidine. Following change in admission protocol to Ranitidine (Group B), incidence of hyponatraemia was 1.6% (1 case). The chance of developing hyponatraemia with Omeprazole was significantly higher than with ranitidine (P=0.0454). Conclusions 10.5% of admissions to the HFU experienced PPI-induced hyponatraemia. The European Medicines Agency defines side effects occurring at greater than 10% as very common. Whilst 45% of patients were on medication associated with hyponatraemia on admission, the absence of hyponatraemia at presentation and biochemical response when switching to ranitidine, demonstrates this is a significant side effect of PPIs. Given the increased morbidity associated with hyponatraemia, particularly in frail, elderly patients, amending protocol to ranitidine for gastric protection has the potential to reduce harm and improve patient outcomes.

Contemporary Pain Management in Elderly Patients after Hip Fracture Surgery

2014 ◽  
pp. 1
Author(s):  
Jenson CS. Mak ◽  
Linda Klein ◽  
Rebecca S. Mason ◽  
Ian D. Cameron
Keyword(s):  
Hip Fracture ◽  
Pain Management ◽  
Elderly Patients ◽  
Hip Fracture Surgery ◽  
Fracture Surgery

scholarly journals Assessment of HIT Antibody Complex in Hip Fracture Patients Receiving Enoxaparin or Unfractionated Heparin

2011 ◽  
Vol 17 (6) ◽  
pp. 567-571
Author(s):  
Justin W. Griffin ◽  
William J. Hopkinson ◽  
Michael R. Lassen ◽  
Indermohan Thethi ◽  
Evangelos Litinas ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Unfractionated Heparin ◽  
Standard Of Care ◽  
The Elderly ◽  
Enzyme Linked Immunosorbent Assay ◽  
Platelet Factor ◽  
Surgical Fixation ◽  
Thrombotic Complications ◽  
Antibody Complex

Thromboembolic disease is a common complication of hip fracture in the elderly. Anticoagulants represent a standard of care in preventing postoperative thrombotic complications following surgical fixation. We asked whether levels of antibody to heparin–platelet factor 4 (PF4) complex were differentially present in unfractionated heparin (UFH) versus Enoxaparin, following hip fracture and whether one particular subtype of antibodies was more prevalent. Plasma samples from elderly patients sustaining a hip fracture treated with either enoxaparin or UFH were collected pre- and postoperatively and analyzed using enzyme-linked immunosorbent assay (ELISA) sandwich method for the prevalence of antiheparin-PF4 antibodies and later subtyped. The prevalence of antiheparin-PF4 antibodies was higher in the UFH group especially on postoperative day 7. Patients treated with UFH showed a greater prevalence of antiheparin-PF4 antibodies and a greater prevalence of immunoglobulin G (IgG) subtype. Heparin and enoxaparin are capable of generating heparin-induced thrombocytopenia (HIT) antibodies in elderly patients undergoing orthopedic surgery but perhaps not to the same extent. When comparing low-molecular-weight heparin (LMWH) with UFH, the incidence of new antiheparin-PF4 antibody production is higher in patients treated with UFH.

scholarly journals Association of ABO blood group with fracture pattern and mortality in hip fracture patients

2014 ◽  
Vol 96 (6) ◽  
pp. 442-445 ◽  
Author(s):  
CE Uzoigwe ◽  
RP Smith ◽  
A Khan ◽  
D Aghedo ◽  
M Venkatesan
Keyword(s):  
Hip Fracture ◽  
Blood Group ◽  
Femoral Fracture ◽  
Intertrochanteric Fracture ◽  
Proximal Femoral Fracture ◽  
Fracture Pattern ◽  
Abo Blood Group ◽  
Blood Group A ◽  
Fracture Configuration ◽  
Group A

Introduction The mechanism of falling has been proposed as the exclusive explanation for hip fracture pattern. Evidence exists that other genetic factors also influence proximal femoral fracture configuration. The ABO blood group serotype has been associated with other pathologies but any role in hip fracture has yet to be definitively characterised. Methods Our National Hip Fracture Database was interrogated over a four-year period. All patients had their blood group retrieved, and this was compared with hip fracture pattern and mortality rates. Confounding factors were accounted for using logistic regression and the Cox proportional hazards model. Results A total of 2,987 consecutive patients presented to our institution. Those with blood group A were significantly more likely to sustain intracapsular fractures than ‘non-A’ individuals (p=0.009). The blood group distribution of patients with intracapsular fractures was identical to that of the national population of England. However, blood group A was less common in patients with intertrochanteric fractures than in the general population (p=0.0002). Even after correction for age and sex, blood group A was associated with a decrease in the odds of suffering an intertrochanteric fracture to 80% (p=0.002). Blood group A had inferior survivorship correcting for age, sex and hip fracture pattern (hazard ratio: 1.14, p=0.035). This may be due to associated increased prevalence of co-morbid disease in this cohort. Conclusions Blood group is an independent predictor of hip fracture pattern, with group A patients more likely to sustain an intracapsular fracture and non-A individuals more likely to sustain an intertrochanteric fracture. The determinants of fracture pattern are likely to be related to complex interactions at a molecular level based on genetic susceptibility. The mechanism of fall may not be the only aetiological determinant of proximal femoral fracture configuration.

scholarly journals Pathologic and Clinical Characteristics of Elderly Patients With Breast Cancer: A Retrospective Analysis of a Multicenter Study (Anatolian Society of Medical Oncology)

2014 ◽  
Vol 99 (1) ◽  
pp. 2-7 ◽  
Author(s):  
Ali İnal ◽  
Tulay Akman ◽  
Sebnem Yaman ◽  
Selcuk Cemil Ozturk ◽  
Caglayan Geredeli ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Retrospective Study ◽  
Elderly Patients ◽  
Older Patients ◽  
The Elderly ◽  
Lymph Node Involvement ◽  
Axillary Lymph ◽  
Breast Cancer Patients ◽  
Number Of Patients ◽  
Er Positive

Abstract There is very little information about breast cancer characteristics, treatment choices, and survival among elderly patients. The purpose of this multicenter retrospective study was to examine the clinical, pathologic, and biologic characteristics of 620 breast cancer patients age 70 years or older. Between June 1991 and May 2012, 620 patients with breast cancer, recruited from 16 institutions, were enrolled in the retrospective study. Patients had smaller tumors at diagnosis; only 15% of patients had tumors larger than 5 cm. The number of patients who had no axillary lymph node involvement was 203 (32.7%). Ninety-three patients (15.0%) had metastatic disease at diagnosis. Patients were characterized by a higher fraction of pure lobular carcinomas (75.3%). The tumors of the elderly patients were also more frequently estrogen receptor (ER) positive (75.2%) and progesterone receptor (PR) positive (67.3%). The local and systemic therapies for breast cancer differed according to age. An association between age and overall survival has not been demonstrated in elderly patients with breast cancer. In conclusion, the biologic behavior of older patients with breast cancer differs from younger patients, and older patients receive different treatments.

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