Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture - A randomised controlled trial
Anna Unneby, Professor Olle Svensson, Professor Yngve Gustafson, Associate Professor Britt-Marie Lindgren, Ulrica Bergström, Professor Birgitta Olofsson, Anna Unneby, Professor Olle Svensson, Professor Yngve Gustafson, Associate Professor Britt-Marie Lindgren, Ulrica Bergström, Professor Birgitta Olofsson
Abstract
Introduction: Patients with hip fracture often suffer complications leading to increased mortality and morbidity. Pain management are important, but opioids has many side effects. The aim of this study was to investigate whether Femoral Nerve Block (FNB) can reduce complications during hospital stay, with special focus on delirium compared to conventional pain management with opioids among patients with hip fracture, including those with dementia.
Patients & methods: In a randomized controlled trial involving patients >70 years with hip fracture (trochanteric and cervical), including those with dementia. Preoperatively, patients (n=236) were consecutively assigned to receive FNB and opioids if required (intervention group, n = 116) or conventional pain management using opioids if required (control group, n = 120). Delirium was set according to different assessments and DSM-IV-TR criteria. Other complications were set by a specialist in geriatric medicine and a trained research nurse according to a predefined protocol.
Results: Most patients, 157 (66%), were women, mean age was 84 (±6.7) years and 109 (46%) patients had dementia disorders. Forty-four patients (38.9%) developed delirium preoperatively in the intervention group compared to 59 (49.2%) patients in the control group (p=0.116). Common postoperative complications were pre- and postoperative delirium, nutritional problems, anaemia, constipation and urinary tract infection with no significant difference between the groups. In the subgroup analysis among patients with dementia, a large proportion developed delirium postoperative (96.3%) and they had a long duration of delirium during hospital stay (5.9 ±1.8), however no difference between the groups.
Conclusion: Despite less preoperative pain and need of opioids, FNB did not reduce the incidence of complications. However, a preoperative FNB may result in less preoperative delirium, but this should be further investigated. As pain treatment, FNB is a good alternative with few documented adverse effects in order to reduce pain and opioids among patients with hip fracture.
Keywords: Complications; Delirium; Dementia; Femoral nerve block; Hip fracture; Opioids; Peripheral Nerve Block.
Conflict of interest statement
Declaration of Competing Interest All of the authors declare that they have no conflict of interest with regard to the content of this study.
Copyright © 2020. Published by Elsevier Ltd.
Source: PubMed