Improving pain and function in hip fracture

改善髋部骨折的疼痛和功能

基本信息

批准号：
7618717
负责人：
R. Sean Morrison
金额：
$ 75.62万
依托单位：
ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
依托单位国家：
美国
项目类别：
财政年份：
2008
资助国家：
美国
起止时间：
2008-05-15 至 2013-04-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7618717
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 Community Hospitals Conduction Anesthesia Constipation Country Delirium Dependence Elderly Emergency Medicine Fascia Fracture Fright Funding Goals Hip Fractures 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 management Patient Self-Report Patients Physical activity Physical therapy Physicians Population Postoperative Pain Postoperative Period Principal Investigator Protocols documentation Randomized Recovery Recovery of Function Rehabilitation therapy Risk Risk Factors Schedule Sedation procedure Site Speed System Tachycardia Techniques Testing Time Translating Treatment Protocols United States Ventilatory Depression Visit Walking Woman Work base conventional therapy experience femoral nerve improved innovation instrumental activity of daily living lifetime risk mortality multidisciplinary primary outcome programs research study secondary outcome trauma centers treatment as usual young adult

项目摘要

DESCRIPTION (provided by applicant): 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.

描述（由申请人提供）：髋部骨折是美国死亡和功能依赖的重要原因。不受控制的疼痛是髋部骨折后恢复的主要障碍，与年轻人相比，疼痛对老年患者髋部骨折结果的影响可能要大得多。例如，疼痛可诱发心动过速、增加心肌需氧量并产生心脏缺血。未经治疗的疼痛与术后并发症和谵妄的风险增加有关，并已被证明会导致长期卧床休息、延迟下床活动、错过或缩短物理治疗疗程、术后六个月功能受损以及住院费用增加。医生不愿意给老年患者开阿片类镇痛药，因为担心会引发副作用（例如便秘、谵妄、镇静、恶心、呼吸抑制），并且研究表明，老年人接受的镇痛药明显少于年轻人。不使用阿片类药物的区域麻醉技术对老年人来说是一种有吸引力的干预措施，但在患者到医院就诊后立即采用区域麻醉技术存在障碍，因此这种选择仅限于小型研究。尽管如此，越来越多的证据表明疼痛是髋部骨折预后较差的独立危险因素，这加大了老年人对有效镇痛策略的需求。该项目探讨股神经阻滞（FNB）和髂筋膜阻滞（FIB）这两种区域麻醉技术在治疗围手术期急性髋部（股骨颈、转子间）骨折疼痛方面的功效和效果。因髋部骨折而到纽约市两个急诊室就诊的 60 岁及以上患者将被随机分配接受干预或常规护理。干预措施包括在急诊室单次注射 FNB，然后在单次注射 FNB 后 24 小时内插入连续 FIB 导管，并根据需要使用非阿片类药物/阿片类药物镇痛。常规护理患者将接受常规治疗，包括定期静脉注射或口服阿片类药物以及根据需要的非/阿片类药物/阿片类药物。我们将检查干预措施对患者自我报告的疼痛强度的影响；全身阿片类药物需求；术后功能；谵妄的发生率、治疗相关的副作用；住院时间和参加物理治疗的情况。