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 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 HIP FRACTURE

2018 ◽  
Vol 25 (01) ◽  
pp. 30-33
Author(s):  
Abdul Malik Shaikh ◽  
Muhammad Bakhsh Shahwani ◽  
Mohammad Ishaq
Keyword(s):  
Hip Fracture ◽  
Pain Score ◽  
Diclofenac Sodium ◽  
Control Group ◽  
College Hospital ◽  
Medical College ◽  
Significant Difference ◽  
Fracture Study ◽  
And Control ◽  
Skin Traction

Objectives: To compare mean pain score between skin traction versus withoutskin traction in cases presenting with hip fracture. Study Design: Multi-randomized controlledstudy. Setting: Department of Orthopaedics, Chandka Medical College Hospital Larkana andQazi Hussain Ahmad Medical Complex, Nowshera. Period: 1st October 2016 to 31st March2017. Materials and Methods: A total of 100 cases (50 in two groups) between 18-60 years ofage including both genders presenting with unilateral femur fracture within 72 hours of injurywere enrolled in this study. They were divided in two groups i.e. study and control group, studygroup was allotted to the cases undergoing traction while control was those without using skintraction. Intramuscular diclofenac sodium injection (75 gm) was used in all participants andfollowed up for two tablets of paracetamol (500 mg) on 8 hourly basis. Visual analogue scaleto record pain score, 0 was no pain and 10 was the severe pain, it was recorded at 24 hoursof application of traction and second measurement was recorded just few minutes before thesurgery is done. Results: In this study, mean age was calculated as 48.74+9.12 years, agerange was 18-60 years. Male participants were in majority by calculating 64% (n=32) in Studyand 58% (n=29) in control group while female cases were 36% (n=18) in cases and 42%(n=21) in control group. Mean pain score at 24 hours of traction in study and control group wasrecorded as 4.60+0.70 in study group and 5.30+0.82 in control group (P = 0.0553), showsa significant difference. Conclusion: Mean pain score is significantly reduced during first 24hours of application of skin traction as compared to those without it in cases with hip fractures,however, it has no significant effect on pain after 24 hours of application.

scholarly journals Effect of mobile guided cardiac rehabilitation on quality of life – the EU-CaRE randomised clinical trial

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
V Houben ◽  
J.A Snoek ◽  
E Prescott ◽  
N Mikkelsen ◽  
A.E Van Der Velde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Elderly Patients ◽  
Cardiac Rehabilitation ◽  
Control Group ◽  
Funding Source ◽  
Multi Centre Study ◽  
Old Patients ◽  
Home Based ◽  
Significant Difference

Abstract Background and purpose Although participation in cardiac rehabilitation (CR) improves quality of life (QoL), participation in CR, especially among elderly, is limited. We conducted this study to assess whether mobile home-based CR (mCR) increases QoL in elderly (≥65 years old) patients with coronary artery disease (CAD) or a valvular intervention who decline participation in conventional CR. Methods It is designed as a randomised multi-centre study with two parallel arms. Randomisation assigned patients either to mCR or a control group. mCR Consisted of six months of home-based CR with telemonitoring and coaching. Control-group patients did not receive any form of CR throughout the study period. Quality of life was measured with the SF-36v2 questionnaire at 0, 6 and 12 months. Results A total of 179 patients were included in this study (90 control, 89 mCR). A flowchart of the trial is presented in Figure 1. Patients were predominantly male (81.1%). Baseline characteristics can be found in Table 1. Patients using mCR improved on physical QoL after 6 (p=0.026) and 12 (p=0.008) months. There was no difference on mental QoL for both groups (mCR 6 months p=0.563, 12 months p=0.945; control 6 months p=0.589, 12 months p=0.542). No difference existed in QoL between the mCR and control group (physical: 6 months p=0.070, 12 months p=0.150; mental: 6 months p=0.355, 12 months p=0.625). Conclusion Although there is no significant difference in QoL between the control and mCR group, mCR increases physical QoL after 6 and 12 months in elderly patients who decline participation in conventional CR. Therefore E-Health tools should be considered as an alternative for conventional CR when (elderly) patients decline to participate in conventional CR. Figure 1. Flow chart of all eligible patients Funding Acknowledgement Type of funding source: Public grant(s) – EU funding. Main funding source(s): European Union's Horizon 2020 research and innovation programme

Correlation Between Intestinal Microflora and Gastrointestinal Dysfunction in Elderly Patients with Sepsis

2020 ◽  
Vol 12 (8) ◽  
pp. 1030-1037
Author(s):  
Hailing Yang ◽  
Xiaolin Zhang ◽  
Weijun Chen ◽  
Libo Shang ◽  
Bin Chen ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Intestinal Microflora ◽  
Sepsis Group ◽  
Control Group ◽  
Gastrointestinal Dysfunction ◽  
E Coli ◽  
Significant Difference ◽  
Prevention And Treatment ◽  
The Common ◽  
Wbc Count

Multiple organ dysfunction syndrome (MODS) is a key factor that leads to death in elderly patients with sepsis. Therefore, early prevention and treatment of gastrointestinal dysfunction (GIDF) in elderly patients with sepsis is an important measure to prevent MODS occurrence. This research explores the correlation between intestinal microflora and GIDF in elderly patients with sepsis and provides ideas for the prevention and treatment of GIDF in elderly patients with sepsis. In this study, 152 patients with sepsis (122 patients with sepsis and GIDF) treated in the Third Affiliated Hospital of Yunnan University of Chinese Medicine from January to September 2019 were selected as the sepsis group and 100 elderly who had normal physical examination results were selected as the control group. The common intestinal microflora of the two groups was compared. Patients with sepsis and GIDF were treated as the GIDF group and the other patients with sepsis were treated as the non-GIDF group. The common intestinal microflora, gastrointestinal indicators, serum inflammatory factors, and immune function indices were compared between the two groups. Correlation analysis of the observed indices with statistical significance was carried out. The results showed 152 patients with sepsis and 122 patients with sepsis and GIDF; thus, the incidence of sepsis with GIDF was 80.26%. The total average score of sepsis with GIDF was 3.61±0.09. There was no statistically significant difference in GIDF scores of patients ages 65–75 and > 75 years old. The number of Bifidobacterium and Lactobacillus in elderly patients with sepsis was lower and the number of Escherichia coli was higher than in the control group. In elderly patients with sepsis, the number of Bifidobacterium and Lactobacillus in the GIDF group was lower and the number of E. coli was higher than in the non-GIDF group. White blood cell (WBC) count, procalcitonin (PCT), C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), gastrin (GAS), and diamine oxidase (DAO) in GIDF patients were higher and motilin (MOT), CIT (CIT), CD4+, and CD8+ were lower than in the non-GIDF group. WBC count, PCT, CRP, TNF-α, GAS, and DAO were negatively correlated with the number of Bifidobacterium and Lactobacillus but positively correlated with E. coli. MOT, CIT, CD4+, and CD8+ were positively correlated with the number of Bifidobacterium and Lactobacillus but negatively correlated with E. coli. There was a negative correlation between Bifidobacterium and Lactobacillus and GIDF score and a positive correlation between E. coli and GIDF score. Therefore, the change in the intestinal microflora in elderly patients with sepsis is related to GIDF.

scholarly journals Therapeutic effect of nifedipine combined with enalapril on elderly patients with coronary heart disease complicated with hypertension

2018 ◽  
Vol 2 (6) ◽  
Author(s):  
Xiaoye Wang
Keyword(s):  
Blood Pressure ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Elderly Patients ◽  
Adverse Reactions ◽  
Effective Rate ◽  
Control Group ◽  
Significant Difference ◽  
Pre Treatment ◽  
Experimental Group

【Abstract】Objective: Toanalyze the efficacy of combined drug therapy for elderly patients with coronary heart disease and hypertension.METHODS:Sixty-six elderly patients with coronary heart disease and hypertension were enrolled from December 2017 to November 2018. They were randomly divided into two groups, 33 patients in each group. Patients in the experimental group received nifedipine. In combination with enalapril, patients enrolled in the control group received nifedipine monotherapy.RESULTS:Compared with the control group, the total effective rate, Serum Nitric Oxide (Serum NO) after treatment, CRP after treatment, HCY after treatment, and blood pressure after treatment were significantly improved (P<0.05). Serum NO and treatment before treatment in the 2 groups. There was no significant difference in pre-CRP, pre-treatment HCY, pre-treatment blood pressure, and adverse reactions during treatment (P>0.05).Conclusion: Theelderly patients with coronary heart disease and hypertension are treated with nifedipine and enalapril.

scholarly journals Correlation of serum PTH level and fracture healing speed in elderly patients with hip fracture

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Zhao-Nan Ban ◽  
Zheng-Jiang Li ◽  
Qi-Shan Gu ◽  
Jun Cheng ◽  
Qiang Huang ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Fracture Healing ◽  
Control Group ◽  
Fracture Group ◽  
Delayed Healing ◽  
Male Patients ◽  
Serum Pth ◽  
Effective Group ◽  
Pth Level

Abstract Purpose To access serum parathyroid hormone (PTH) level in elderly patients with hip fracture in relation to fracture healing outcomes. Methods This study included 90 elderly male patients with hip fracture and they were defined as the hip fracture group, and they were divided into healing effective group and delayed healing group by final fracture healing outcomes, 45 cases in each group; another 45 male patients older than 70 years without established osteoporosis and hip fracture were included as the control group. The levels of serum PTH level were examined in each group. Results Serum PTH level was significantly higher in healing effective group patients at the 7 days and 14 days after fracture than the delayed healing patients. Conclusions Our results show that serum PTH level may be an effective indicator of hip fracture delayed healing risk in the elderly.

scholarly journals Predictive nomogram for postoperative delirium in elderly patients with a hip fracture

Injury ◽  
2019 ◽  
Vol 50 (2) ◽  
pp. 392-397 ◽  
Author(s):  
Xin Zhang ◽  
Da-ke Tong ◽  
Fang Ji ◽  
Xu-zhou Duan ◽  
Pei-zhao Liu ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Elderly Patients ◽  
Postoperative Delirium

scholarly journals Effectiveness of Transversus Abdominis Plane Block for Postoperative Analgesia in Obstetric Cases Undergoing Caesarean Section

2019 ◽  
Vol 4 (2) ◽  
pp. 755-758
Author(s):  
Roshan Pradhan ◽  
Seema Kumari Mishra ◽  
Lalit Kumar Rajbanshi ◽  
Kanak Khanal ◽  
Batsalya Arjyal ◽  
...  
Keyword(s):  
Caesarean Section ◽  
Pain Score ◽  
Postoperative Analgesia ◽  
Transversus Abdominis ◽  
Control Group ◽  
Tap Block ◽  
Transversus Abdominis Plane ◽  
Rescue Analgesia ◽  
Visual Analogue Pain ◽  
Significant Difference

Introduction: Transversus abdominis plane (TAP) block is a regional anesthesia that involves the infiltration of local anesthetic in between the internal oblique and transversus abdominis muscle plane. This block provides post-operative analgesia and reduces the requirement of opioids consumption. Objective: To assess the effectiveness of TAP block in providing postoperative analgesia in women undergoing caesarean section. Methodology: This was a hospital based prospective, comparative, cross sectional study conducted in 70 patients from 17th September 2018 to 17th February 2019 undergoing caesarean section under spinal anesthesia. Patients were divided into two groups. Group A patients received TAP block with 0.5% Ropivacaine versus Group B patients received injection paracetamol 1gm intravenous every 8 hourly as a standard and routine analgesic. At the end of the surgery, TAP block was performed by anesthesiologist and assessment of postoperative pain using a visual analogue pain score at every 1 hour, 3 hour, 6 hour, 12 hour and 24 hour by trained staffs at postoperative ward. Then, depending upon the severity of the pain injection fentanyl 1mcg/kg intravenous was given as rescue analgesia. Short assessment of patient satisfaction (SAPS) score was also assessed 24 hours postoperatively. Results: Compared to control group, in women who received TAP block, there was statistically significant reduction in pain at 3 hr, 6 hr, 24 hrs. However at 12 hrs there was no significant difference in the pain score. The cumulative fentanyl requirement was also significantly less in the TAP block group at all the time points.  Conclusion: The TAP block provided highly effective postoperative analgesia following caesarean section and reduces the fentanyl requirement in the first 24 hour.

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