Limits...
Local Anaesthetic Infiltration and Indwelling Postoperative Wound Catheters for Patients with Hip Fracture Reduce Death Rates and Length of Stay.

Harrison WD, Lees D, A'Court J, Ankers T, Harper I, Inman D, Reed MR - Surg Res Pract (2015)

Bottom Line: Pain scores were significantly reduced in the full ER group, p < 0.0001.Conclusions.This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.

ABSTRACT
Background. An analgesic enhanced recovery (ER) protocol for patients with a hip fracture was introduced. It was hypothesised that the ER would reduce pain, length of stay and improve clinical outcomes. The protocol used intraoperative infiltration of levobupivacaine followed by ongoing wound infusions. Methods. Consecutive patients admitted to two hospitals were eligible for the ER protocol. Numerical Reporting Scale pain scores (0-10) were recorded alongside opiate requirements. 434 patients in the ER group (316 full ER, 90 partial ER, and 28 no ER) were compared to a control group (CG) of 100 consecutive patients managed with traditional opiate analgesia. Results. Mean opiate requirement was 49.2 mg (CG) versus 32.5 mg (ER). Pain scores were significantly reduced in the full ER group, p < 0.0001. Direct discharge home and mean acute inpatient stay were significantly reduced (p = 0.0031 and p < 0.0001, resp.). 30-day mortality was 15% (CG) versus 5.5% (ER), p = 0.0024. Conclusions. This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality.

No MeSH data available.


Related in: MedlinePlus

Numerical Reporting Scale (NRS) pain scores for the control group and the enhanced recovery subgroups.
© Copyright Policy - open-access
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4663367&req=5

fig1: Numerical Reporting Scale (NRS) pain scores for the control group and the enhanced recovery subgroups.

Mentions: Figure 1 demonstrates that cognitively intact patients in the CG reported significantly higher pain over the first 3 days compared to the cognitively intact members of the full ER, p < 0.0001. The LIA initially reported low pains scores compared to the CG, but by 6 hours NRS pain scores were higher in the LIA. Patients with CATH had a higher level of pain compared to the CG despite equivalent regular and as required analgesia. Patterns of NRS pain scores in the subgroups of the enhanced recovery protocol matched the patterns in opiate requirement, as seen in Table 4.


Local Anaesthetic Infiltration and Indwelling Postoperative Wound Catheters for Patients with Hip Fracture Reduce Death Rates and Length of Stay.

Harrison WD, Lees D, A'Court J, Ankers T, Harper I, Inman D, Reed MR - Surg Res Pract (2015)

Numerical Reporting Scale (NRS) pain scores for the control group and the enhanced recovery subgroups.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4663367&req=5

fig1: Numerical Reporting Scale (NRS) pain scores for the control group and the enhanced recovery subgroups.
Mentions: Figure 1 demonstrates that cognitively intact patients in the CG reported significantly higher pain over the first 3 days compared to the cognitively intact members of the full ER, p < 0.0001. The LIA initially reported low pains scores compared to the CG, but by 6 hours NRS pain scores were higher in the LIA. Patients with CATH had a higher level of pain compared to the CG despite equivalent regular and as required analgesia. Patterns of NRS pain scores in the subgroups of the enhanced recovery protocol matched the patterns in opiate requirement, as seen in Table 4.

Bottom Line: Pain scores were significantly reduced in the full ER group, p < 0.0001.Conclusions.This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality.

View Article: PubMed Central - PubMed

Affiliation: Orthopaedic Department, Wansbeck General Hospital, Northumbria Healthcare Trust, Woodhorn Lane, Ashington, Northumberland NE63 9JJ, UK.

ABSTRACT
Background. An analgesic enhanced recovery (ER) protocol for patients with a hip fracture was introduced. It was hypothesised that the ER would reduce pain, length of stay and improve clinical outcomes. The protocol used intraoperative infiltration of levobupivacaine followed by ongoing wound infusions. Methods. Consecutive patients admitted to two hospitals were eligible for the ER protocol. Numerical Reporting Scale pain scores (0-10) were recorded alongside opiate requirements. 434 patients in the ER group (316 full ER, 90 partial ER, and 28 no ER) were compared to a control group (CG) of 100 consecutive patients managed with traditional opiate analgesia. Results. Mean opiate requirement was 49.2 mg (CG) versus 32.5 mg (ER). Pain scores were significantly reduced in the full ER group, p < 0.0001. Direct discharge home and mean acute inpatient stay were significantly reduced (p = 0.0031 and p < 0.0001, resp.). 30-day mortality was 15% (CG) versus 5.5% (ER), p = 0.0024. Conclusions. This analgesic ER protocol for patients with a hip fracture was safe and effective and was associated with reduced inpatient stay and mortality.

No MeSH data available.


Related in: MedlinePlus