Regional nerve blockade for early analgesic management of elderly patients with hip fracture - a narrative review
| Autor: | Steven G Faux, J. Stevens, Christine T. Shiner, A. Scurrah |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
Analgesic 03 medical and health sciences 0302 clinical medicine Anesthesia Conduction 030202 anesthesiology Pain assessment Humans Pain Management Medicine Intensive care medicine Aged Aged 80 and over Hip fracture Hip Fractures business.industry Fascia iliaca block Nerve Block 030208 emergency & critical care medicine medicine.disease Anesthesiology and Pain Medicine Nerve Blockade Delirium Narrative review Analgesia medicine.symptom business Pain Protocols |
| Zdroj: | Anaesthesia. 73:769-783 |
| ISSN: | 0003-2409 |
| DOI: | 10.1111/anae.14178 |
| Popis: | Elderly patients with hip fracture experience high morbidity and mortality, and are often undertreated for pain. Acute pain management in the elderly is challenging, with physiological frailty, medical comorbidities and cognitive impairment commonly compounding pain assessment and treatment. Guidelines outlining current best practice for acute pain management in the elderly now exist, but evidence suggests that practice remains variable and there continues to be scope for improvement. We conducted a narrative review of the literature to examine the challenges of acute pain management in the elderly, and to evaluate evidence for the role of regional nerve blocks for acute pain associated with hip fracture in the elderly. There is consistent evidence that regional nerve blocks can effectively reduce pain associated with hip fracture, providing rapid-onset, site-specific analgesia that is more effective than standard systemic analgesia alone. There is also moderate evidence that nerve blocks may contribute to reduced rates of delirium, and some suggestion of reduced length of inpatient stay, morbidity and mortality, although limited evidence is available. Fascia iliaca blocks are emerging as a block of choice, with evidence they can be safely and rapidly administered under ultrasound guidance in the acute setting, by both trained medical and nursing staff, with good effect. Ideally, comprehensive pain protocols for elderly hip fracture patients are required, that integrate evidence-based fascia iliaca block use, timely and repeated pain assessment, and multidisciplinary orthogeriatric patient care. |
| Databáze: | OpenAIRE |
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