A comparison of clinical practice guidelines for proximal femoral fracture

Abstract

SummaryClinical practice guidelines are designed to assist clinical decision-making by summarising evidence and forming recommendations. The number of available guidelines is vast and they vary in relevance and quality. We reviewed guidelines relevant to the management of a patient with a fractured neck of femur and explored similarities and conflicts between recommendations. As guidelines are often produced in response to an area of clinical uncertainty, recommendations differ. This can result in a situation where the management of a particular clinical problem will depend upon which guideline is followed. We explore the reasons for such differences.

Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study

“…Recently, numerous experts stated the effectiveness of these methods not only on pain [4][5][6][7] but also on functional outcome and on length of stay [16].…”

“…The addition of nerve blocks may allow a sparing in the doses of analgesics intravenously [4] and to improve the postoperative course particularly in proximal femoral fracture [5,6] and if a continuous infusion in the postoperative period is applied [7].…”

Current Approaches in Hip and Knee Arthroplasty Anaesthesia

“…Postoperatif erken dönemde ortaya çıkan ağrıyı azaltmak için multimodal analjezi tekniğinin bir parçası olarak lokal infiltrasyon analjezisi önerilir. Periferik sinir bloklarına bağlı olarak kaslarda ortaya çıkan zayıflık özellikle mobilizasyon sırasında düşmelere neden olabilir (45)(46)(47)(48)(49)(50)(51)(52)(53). Bunun önüne geçmek için bu hasta grubunda periartiküler enjeksiyon önerilir.…”

“…Sonra tekrar yatağına yatırılır. Bu işlem ameliyathanede derlenme ünitesinde veya serviste gerçekleştirilir (53)(54)(55)(56)(57)(58)(59).…”

Management of Pain in the Emergency Department

“…The problem is not so much one of diagnostic clouding by analgesics (although this is sometimes an issue), as it is the risking of physiologic compromise from opioids [229]. Concerns for respiratory and hemodynamic depression from analgesics are often bruited as rationale for withholding of trauma analgesia, but trauma analgesia can be safely improved and provided with educational programs that incorporate emphasis on judicious medication use [3,25,196,[230][231][232][233].…”