Improving pain and function in hip fracture

改善髋部骨折的疼痛和功能

• 批准号: 8063100
• 负责人: R. Sean Morrison
• 金额: $ 76.14万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-15 至 2013-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8063100
• 关键词: Absence of pain sensation; Accident and Emergency department; Acetaminophen; Activities of Daily Living; Acute; Admission activity; Adult; Adverse effects; Age; Analgesics; Anesthesia procedures; Anesthetics; Bed rest; Cardiac; Caring; Catheters; Cessation of life; Community Hospitals; Conduction Anesthesia; Constipation; Country; Delirium; Dependence; Disease; Elderly; Emergency Medicine; Fascia; Fracture; Fright; Funding; Goals; Hip Fractures; Hip Pain; Hip region structure; Hospital Costs; Hospitals; Hour; Incidence; Injection of therapeutic agent; Intertrochanteric Fractures; Intervention; Intravenous; Ischemia; Israel; Lead; Length of Stay; Life Expectancy; Measures; Medical center; Medicare; Morphine; Myocardial; Nausea; Neck; Nerve Block; New York City; Operative Surgical Procedures; Opioid; Opioid Analgesics; Oral; Orthopedics; Outcome; Oxygen; Pain; Pain intensity; Pain management; Patient Self-Report; Patients; Physical activity; Physical therapy; Physicians; Population; Postoperative Pain; Postoperative Period; Protocols documentation; Randomized; Recovery; Recovery of Function; Regimen; Rehabilitation therapy; Research; Risk; Risk Factors; Schedule; Sedation procedure; Site; Speed; System; Tachycardia; Techniques; Testing; Time; Translating; United States; Ventilatory Depression; Visit; Walking; Woman; Work; adverse outcome; base; conventional therapy; disability; effective intervention; experience; femoral nerve; improved; innovation; instrumental activity of daily living; intervention effect; lifetime risk; medical complication; mortality; multidisciplinary; novel; primary outcome; research study; secondary outcome; trauma centers; treatment as usual; young adult

Hip fractures are an important cause of mortality and functional dependence in the United States. Uncontrolled pain is a major impediment to recovery following hip fracture and pain may have a disproportionately greater impact on hip fracture outcomes in geriatric patients than in younger adults. For example, pain can induce tachycardia, increase myocardial oxygen requirements, and produce cardiac ischemia. Untreated pain has been associated with an increased risk of post-operative complications and delirium and has been shown to lead to prolonged bed rest, delayed ambulation, missed or shortened physical therapy sessions, impaired function six months following surgery, and increased hospital costs. Physicians are reluctant to prescribe opioid analgesics to geriatric patients for fear of precipitating side effects (e.g., constipation, delirium, sedation, nausea, respiratory depression) and studies suggest that older adults receive significantly less analgesia than younger adults. Opioid sparing regional anaesthesia techniques represent an attractive intervention in older adults but barriers to undertaking regional techniques immediately upon presentation of patients to the hospital have limited this option to small research studies. Nonetheless, the increasing evidence of pain as an independent risk factor for poorer outcomes in hip fracture heightens the need for effective analgesic strategies for older adults. This project examines the efficacy and effects of 2 regional anesthesia techniques, femoral nerve blocks (FNB) and fascia iliaca blocks (FIB), on the treatment of peri-operative acute hip (femoral neck, intertrochanteric) fracture pain. Patients age 60 years and over presenting to two New York City emergency departments with hip fracture will be randomized to receive the intervention or usual care. The intervention includes single injection FNB in the ED followed by insertion of a continuous FIB catheter within 24 hours of the single injection FNB plus ?as needed? non-opioid/opioid analgesia. Usual care patients will receive conventional therapy with regularly scheduled intravenous or oral opioids plus ?as needed? non/opioids/opioids. We will examine the impact of the intervention on patients' self reported pain intensity; systemic opioid requirements; post-operative function; incidence of delirium, treatment related side effects; and hospital length of stay and participation in physical therapy.

髋部骨折是美国死亡率和功能依赖性的重要原因。 不受控制的疼痛是髋部骨折后恢复的主要障碍，疼痛可能有 与年轻人相比，老年患者对髋部骨折结局的影响不成比例。为了 例如，疼痛会引起心动过速，增加心肌氧的需求并产生心脏 缺血。未经治疗的疼痛与术后并发症的风险增加有关 del妄，已被证明会导致长时间的床休息，延迟移动，遗失或缩短身体 治疗课程，手术后六个月的功能受损以及增加医院费用。医师是 由于担心会导致副作用，因此不愿向老年患者开非阿片类镇痛药（例如 便秘，del妄，镇静，恶心，呼吸道抑郁），研究表明老年人接受 比年轻人明显少得多。 阿片类药物保留区域麻醉技术代表了老年人的有吸引力的干预措施，但 将患者介绍给医院后立即采取区域技术的障碍 将此选项限制在小型研究中。但是，越来越多的痛苦证据作为独立 髋部骨折结果较差的危险因素增加了对老年有效镇痛策略的需求 成年人。该项目检查了2种区域麻醉技术，股神经的功效和影响 骨术急性髋关节治疗（股骨颈， 跨金融）骨折疼痛。年龄60岁及以上的患者向两个纽约市紧急情况介绍 髋部骨折的部门将被随机分配以接受干预或通常的护理。干预 包括在ED中的单个注射FNB，然后在24小时内插入连续的FIB导管 单注射FNB Plus？非阿片类/阿片类镇痛。通常的护理患者会收到 常规疗法，定期安排的静脉或口服阿片类药物加上？非/阿片类药物/阿片类药物。 我们将研究干预对患者自我报告的疼痛强度的影响；全身阿片类药物 要求;术后功能； ir妄的发生率，相关的副作用；和医院长度 住宿和参与物理治疗。