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

  • Anastasiia Romanenko “Oberig” Medical Center, Kyiv
  • Iurii Kuchyn Bogomolets National Medical University
  • Kateryna Bielka Bogomolets National Medical University
  • Igor Tokar «Into-Sana» Medical Center
Keywords: analgesia, femoral fracture, psoas compartment block, paracetamol, opioids, delirium

Abstract

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.

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Author Biographies

Iurii Kuchyn , Bogomolets National Medical University

MD, DMS, Professor, Chairman of the Department of Surgery, Anesthesiology and Intensive Care for Postgraduate Education, Bogomolets National Medical

Kateryna Bielka, Bogomolets National Medical University

Associate Professor of the Department of Surgery, Anesthesiology and Intensive care for Postgraduate Education, Bogomolets National Medical University

Igor Tokar, «Into-Sana» Medical Center

Chief of the Department of Anesthesiology and Intensive care of «Into-Sana» Medical Center

References

Davenport M, Trevor JM. Hip Fracture in Emergency Medicine Clinical Presentation [Internet]. Medscape, emergency medicine. Feb 28, 2016. https://emedicine.medscape.com/article/825363-clinical

Lockhart TE, Smith JL, Woldstad JC. Effects of Aging on the Biomechanics of Slips and Falls. Human Factors: The Journal of the Human Factors and Ergonomics Society [Internet]. SAGE Publications; 2005 Dec;47(4):708–29. Available from: https://doi. org/10.1518/001872005775571014

Hung WW, Egol KA, Zuckerman JD, Siu AL. Hip Fracture Management. JAMA [Internet]. American Medical Association (AMA); 2012 May 23;307(20). Available from: https://doi.org/10.1001/ jama.2012.4842

Maxwell L, White S. Anaesthetic management of patients with hip fractures: an update. Continuing Education in Anaesthesia Critical Care & Pain [Internet]. Elsevier BV; 2013 Oct;13(5):179–83. Available from: https://doi.org/10.1093/bjaceaccp/mkt006

Ahsan-ul-Haq M, Amin S, Javaid S. Paramedian technique of spinal anesthesia in elderly patients for hip fracture surgery. J Coll Physicians Surg Pak. 2005 Mar;15(3):160–1.

Al-Ani AN, Flodin L, S derqvist A, Ackermann P, Samneg rd E, Dal n N, et al. Does Rehabilitation Matter in Patients With Femoral Neck Fracture and Cognitive Impairment? A Prospective Study of 246 Patients. Archives of Physical Medicine and Rehabilitation [Internet]. Elsevier BV; 2010 Jan;91(1):51–7. Available from: https://doi. org/10.1016/j.apmr.2009.09.005

Ambulkar R, Shankar R. Analgesia after total hip replacement. Anaesthesia [Internet]. Wiley; 2006 May;61(5):507–507. Available from: https://doi.org/10.1111/j.1365–2044.2006.04625.x

Abou-Setta AM, Beaupre LA, Jones CA, at al. Pain Management Interventions for Hip Fracture. Comparative Effectiveness Review No. 30. (Prepared by the University of Alberta Evidence-based Practice Center under Contract No. 290–02–0023.) AHRQ Publication No. 11-EHC022-EF. Rockville, MD: Agency for Healthcare Research and Quality. May 2011. Available at: www.effectivehealthcare.ahrq.gov/reports/final.cfm

Bone and Joint in Brief. Lippincott’s Bone and Joint Newsletter [Internet]. Ovid Technologies (Wolters Kluwer Health); 2009 Oct;15(9):108. Available from: https://doi.org/10.1097/01.bonej.0000361456.46870.3e

Bozdogan N, Caliskan E, Turkoz R. Combination of Regional Anesthetic Blocks for Femoropopliteal Bypass Surgery. Journal of Cardiothoracic and Vascular Anesthesia [Internet]. Elsevier BV; 2009 Jun;23(3):442. Available from: https://doi.org/10.1053/j. jvca.2008.05.010

Sanzone AG. Current Challenges in Pain Management in Hip Fracture Patients. Journal of Orthopaedic Trauma [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 May;30:S1–S5. Available from: https://doi.org/10.1097/bot.0000000000000562

Griffiths R, Alper J, Beckingsale A, Goldhill D, Heyburn G, et al. Management of proximal femoral fractures 2011. Anaesthesia [Internet]. Wiley; 2011 Dec 12;67(1):85–98. Available from: https://doi. org/10.1111/j.1365–2044.2011.06957.x

Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander-Knauer U, Roth T, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporosis International [Internet]. Springer Science and Business Media LLC; 2010 Nov 6;21(S4):555–72. Available from: https:// doi.org/10.1007/s00198–010–1399–7

Hallqvist L, Granath F, Huldt E, Bell M. Intraoperative hypotension is associated with acute kidney injury in noncardiac surgery. European Journal of Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2018 Apr;35(4):273–9. Available from: https://doi.org/10.1097/eja.0000000000000735

National Clinical Guideline Centre, (2011) [The Management of Hip Fracture in Adults]. Last updated: May 2017 London: National Clinical Guideline Centre. Available from: https://www.nice.org.uk/ guidance/cg124

White SM, Moppett IK, Griffiths R. Outcome by mode of anaesthesia for hip fracture surgery. An observational audit of 65 535 patients in a national dataset. Anaesthesia [Internet]. Wiley; 2014 Jan 15;69(3):224–30. Available from: https://doi.org/10.1111/ anae.12542

Matot I, Oppenheim-Eden A, Ratrot R, Baranova J, Davidson E, Eylon S, et al. Preoperative Cardiac Events in Elderly Patients with Hip Fracture Randomized to Epidural or Conventional Analgesia. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2003 Jan;98(1):156–63. Available from: https://doi. org/10.1097/00000542–200301000–00025

Wood RJ, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia [Internet]. Wiley; 2011 Aug 18;66(11):1017–22. Available from: https://doi.org/10.1111/ j.1365–2044.2011.06854.x

Foss NB, Kristensen MT, Kristensen BB, Jensen PS, Kehlet H. Effect of Postoperative Epidural Analgesia on Rehabilitation and Pain after Hip Fracture Surgery. Anesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2005 Jun;102(6):1197–204. Available from: https://doi.org/10.1097/00000542–200506000– 00020

Naples JG, Gellad WF, Hanlon JT. The Role of Opioid Analgesics in Geriatric Pain Management. Clinics in Geriatric Medicine [Internet]. Elsevier BV; 2016 Nov;32(4):725–35. Available from: https://doi. org/10.1016/j.cger.2016.06.006

Petre BM, Roxbury CR, McCallum JR, DeFontes KW, Belkoff SM, Mears SC. Pain Reporting, Opiate Dosing, and the Adverse Effects of Opiates After Hip or Knee Replacement in Patients 60 Years Old or Older. Geriatric Orthopaedic Surgery & Rehabilitation [Internet]. SAGE Publications; 2012 Feb 9;3(1):3–7. Available from: https:// doi.org/10.1177/2151458511432758

Hargett JL, Criswell AC. Non-pharmacological interventions for acute pain management in patients with opioid abuse or opioid tolerance. JBI Database of Systematic Reviews and Implementation Reports [Internet]. Ovid Technologies (Wolters Kluwer Health); 2019 Jul;17(7):1283–9. Available from: https://doi.org/10.11124/ jbisrir-2017–003878

Sanzone AG. Current Challenges in Pain Management in Hip Fracture Patients. Journal of Orthopaedic Trauma [Internet]. Ovid Technologies (Wolters Kluwer Health); 2016 May;30:S1–S5. Available from: https://doi.org/10.1097/bot.0000000000000562

National Clinical Guideline Centre, (2011) [The Management of Hip Fracture in Adults]. Last updated: May 2017. London: National Clinical Guideline Centre. Available from: https://www.nice.org.uk/ guidance/cg124

Remy C, Marret E, Bonnet F. State of the art of paracetamol in acute pain therapy. Current Opinion in Anaesthesiology [Internet]. Ovid Technologies (Wolters Kluwer Health); 2006 Oct;19(5):562–5. Available from: https://doi.org/10.1097/01. aco.0000245285.30282.70

Jibril F, Sharaby S, Mohamed A, Wilby KJ. Intravenous versus Oral Acetaminophen for Pain: Systematic Review of Current Evidence to Support Clinical Decision-Making. The Canadian Journal of Hospital Pharmacy [Internet]. Canadian Society of Hospital Pharmacists (CSHP); 2015 Jun 25;68(3). Available from: https://doi. org/10.4212/cjhp.v68i3.1458

Peduto VA, Ballabio M, Stefanini S. Efficacy of propacetamol in the treatment of postoperative pain Morphine-sparing effect in orthopedic surgery. Acta Anaesthesiologica Scandinavica [Internet]. Wiley; 1998 Mar;42(3):293–8. Available from: https://doi. org/10.1111/j.1399–6576.1998.tb04919.x

Dixon J, Ashton F, Baker P, Charlton K, Bates C, Eardley W. Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol. Geriatric Orthopaedic Surgery & Rehabilitation [Internet]. SAGE Publications; 2018 Jan;9:215145931880644. Available from: https://doi.org/10.1177/2151459318806443

Bollinger AJ, Butler PD, Nies MS, Sietsema DL, Jones CB, Endres TJ. Is Scheduled Intravenous Acetaminophen Effective in the Pain Management Protocol of Geriatric Hip Fractures? Geriatric Orthopaedic Surgery & Rehabilitation [Internet]. SAGE Publications; 2015 May 31;6(3):202–8. Available from: https://doi. org/10.1177/2151458515588560

Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2018 May;126(5):1695–704. Available from: https://doi.org/10.1213/ane.0000000000002489

Parker MJ, Griffiths R, Appadu B. Nerve blocks (subcostal, lateral cutaneous, femoral, triple, psoas) for hip fractures. Parker MJ, editor. Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2002 Jan 21; Available from: https://doi. org/10.1002/14651858.cd001159

Morgenstern J. Femoral nerve block for hip fractures: the evidence. First10EM blog: August 29, 2018. Available at: https://first10em. com/femoral-nerve-blocks/.

Lumbar Paravertebral Sonography and Considerations for Ultrasound-Guided Lumbar Plexus Block. NYSORA. Available at: https://www.nysora.com/regional-anesthesia-for-specific-surgical-procedures/lower-extremity-regional-anesthesia-for-specific-surgical-procedures/anesthesia-and-analgesia-for-hip-procedures/lumbar-paravertebral-sonography-considerations-ultrasound-guided-lumbar-plexus-block

Bassem A, Raghavendra M. Psoas Compartment Block [Internet]. Medscape. Updated: Jan 10, 2018. https://emedicine.medscape. com/article/2000722-overview

Mannion S. Psoas compartment block. Continuing Education in Anaesthesia Critical Care & Pain [Internet]. Elsevier BV; 2007 Oct;7(5):162–6. Available from: https://doi.org/10.1093/bjaceaccp/mkm029

Morrison RS, Dickman E, Hwang U, Akhtar S, Ferguson T, Huang J, et al. Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial. Journal of the American Geriatrics Society [Internet]. Wiley; 2016 Oct 27;64(12):2433– 9. Available from: https://doi.org/10.1111/jgs.14386

Guay J, Parker MJ, Griffiths R, Kopp SL. Peripheral Nerve Blocks for Hip Fractures. Anesthesia & Analgesia [Internet]. Ovid Technologies (Wolters Kluwer Health); 2018 May;126(5):1695–704. Available from: https://doi.org/10.1213/ane.0000000000002489

St. Louis D, Iverson K, Forget N. Fascia Iliaca Compartment Block Efficacy in Resource-poor Emergency Departments. Clinical Practice and Cases in Emergency Medicine [Internet]. Western Journal of Emergency Medicine; 2018 Sep 28;2(4):286–90. Available from: https://doi.org/10.5811/cpcem.2018.9.39208

Parker MJ, Handoll HH. Pre-operative traction for fractures of the proximal femur in adults. Parker MJ, editor. Cochrane Database of Systematic Reviews [Internet]. John Wiley & Sons, Ltd; 2006 Jul 19; Available from: https://doi.org/10.1002/14651858. cd000168.pub2

Published
2020-02-08
How to Cite
1.
Romanenko A, Kuchyn I, Bielka K, Tokar I. Perioperative pain management in elderly patients with а proximal femoral fracture: evidence review. PMJUA [Internet]. 2020Feb.8 [cited 2020Feb.29];4(4):42-9. Available from: https://painmedicine.org.ua/index.php/pnmdcn/article/view/200