Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol

Dixon, Ján; Ashton, Fiona; Baker, Paul; Charlton, Karl; Bates, Charlotte; Eardley, William

doi:10.1177/2151459318806443

Cited by 31 publications

(25 citation statements)

References 38 publications

(103 reference statements)

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“…This contrasts directly with the association of cognitive impairment with other areas of perioperative management, namely, pain control, whereby patients with cognitive impairment are known to receive poorer pain management. 14 We found that there was no meaningful difference in nutritional practice in the presence of cognitive impairment, suggesting that cognitively impaired hip fracture patients receive comparable nutritional management to cognitively intact patients.…”

Section: Discussionmentioning

confidence: 65%

Nutrition in Hip Fracture Units: Contemporary Practices in Preoperative Supplementation

Dixon

Channell

Arkley

et al. 2019

Geriatr Orthop Surg Rehabil

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Introduction: Patients with hip fractures pose a significant burden on health services. Malnutrition, frailty, and cognitive impairment are common, and key to addressing the needs of this vulnerable patient group is nutrition optimization, including reduction in arbitrary nil by mouth (NBM) perioperative regimens. In order to understand current practices, we characterize preoperative nutrition in a regional hip fracture population. Methods: Prospective data were submitted to the National Hip Fracture Database by 6 hospitals in the north east of England over a 6-month period. Patients were stratified by preoperative nutritional intake, frailty, and cognitive function. Results: In all, 24.2% (n = 205) patients received no oral intake at all preoperatively; 15.3% of NBM patients were at risk of malnutrition; and 6.9% were malnourished at the time of assessment. Median time to surgery for NBM patients was 16.75 hours, and 6.34% of patients were fasted with no intake for >36 hours. In all, 6.5% (n = 44) of patients with an Abbreviated Mental Test Score (AMTS) of 8 or above were deemed to be at risk of malnutrition at admission, compared to 11.3% (n = 50) of patients with an AMTS of 7 or below. The NBM patients had similar mean Rockwood (4.97) and AMTS (6.51) scores to patients given oral nutrition. Conclusion: We have demonstrated contemporary preoperative nutritional practices in the management of over 800 hip fracture patients. Contrary to perception, nutrition practices vary little when stratified for age, cognition frailty, or comorbid burden. We have identified widespread prolonged NBM fasting and undersupplementation in patients sustaining hip fracture across a region. This work suggests a need to focus less on patient factors and more on systematic practices.

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Section: Discussionmentioning

confidence: 65%

Nutrition in Hip Fracture Units: Contemporary Practices in Preoperative Supplementation

Dixon

Channell

Arkley

et al. 2019

Geriatr Orthop Surg Rehabil

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“…We identified 3570 potentially relevant publications, of which 36 systematic reviews 15‐50 were ultimately included in our analysis (Box 1; , table 3). Of 112 publications deemed potentially eligible by abstract review, 76 were excluded after reviewing the full text (Box 1; , table 4); the conclusions of excluded reviews that covered the same topic as reviews included in our overview are summarised in , table 5.…”

Section: Resultsmentioning

confidence: 99%

“…The 36 reviews described treatment with paracetamol of 44 painful conditions in adults and children (Box 2). Twenty systematic reviews reported efficacy estimates that we included in our analysis, and we calculated efficacy estimates for 12 reviews; four reviews (paracetamol for treating neuropathic pain, 38 hip fracture, 41 chronic non‐cancer pain in children, 40 and cancer pain in adults 39 ) did not include evidence from RCTs. A comprehensive summary of the converted effect estimates is included in , table 6.…”

Section: Resultsmentioning

confidence: 99%

“…Very low quality evidence was deemed inconclusive, even if the effect estimate was statistically significant. Evidence regarding the value of paracetamol was insufficient to guide treatment in seventeen pain conditions for which RCT evidence was available: chronic low back pain, 28 post‐caesarean delivery pain 45 (multiple‐dose regimens), prevention of post‐operative pain at rest, 23 endodontic surgery pain, 37 knee and hip arthroplasty 42 (single or multiple dose regimens), abdominal surgery 32 (multiple dose regimens), rheumatoid arthritis, 16 hip fracture, 41 tonsillectomy in adults, 47 laparoscopic cholecystectomy, 21 catheter‐related bladder discomfort, 22 myringotomy in children, 48 bariatric surgery, 43 cardiac surgery, 33 and diverse post‐operative pain conditions (thyroidectomy, lower extremity, lumbar disk, nephrolithotomy) 26 (Box 3). Evidence regarding its value in four conditions without RCT evidence was also very low quality: non‐cancer pain in children and adolescents, 40 neuropathic pain, 38 cancer pain in adults, 39 and hip fracture 41 …”

Section: Resultsmentioning

confidence: 99%

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The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews

Shaheed

Ferreira

Dmitritchenko

et al. 2021

Medical Journal of Australia

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Objective To evaluate the efficacy and safety of paracetamol as an analgesic medication in a range of painful conditions. Study design Systematic review of systematic reviews of the analgesic effects of paracetamol in randomised, placebo‐controlled trials. Conduct of systematic reviews was assessed with AMSTAR‐2; confidence in effect estimates (quality of evidence) was assessed with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria. Data sources MEDLINE, EMBASE, PsycINFO, Cochrane Database of Systematic Reviews; systematic reviews published 1 January 2010 – 30 April 2020. Data synthesis We extracted pain and adverse events outcomes from 36 systematic reviews that assessed the efficacy of paracetamol in 44 painful conditions. Continuous pain outcomes were expressed as mean differences (MDs; standardised 0–10‐point scale); dichotomous outcomes were expressed as risk ratios (RRs). There is high quality evidence that paracetamol provides modest pain relief for people with knee or hip osteoarthritis (MD, –0.3 points; 95% CI, –0.6 to –0.1 points) and after craniotomy (MD, –0.8 points; 95% CI, –1.4 to –0.2 points); there is moderate quality evidence for its efficacy in tension‐type headache (pain‐free at 2 hours: RR, 1.3; 95% CI, 1.1–1.4) and perineal pain soon after childbirth (patients experiencing 50% pain relief: RR, 2.4; 95% CI, 1.5–3.8). There is high quality evidence that paracetamol is not effective for relieving acute low back pain (MD, 0.2 points; 95% CI, –0.1 to 0.4 points). Evidence regarding efficacy in other conditions was of low or very low quality. Frequency of adverse events was generally similar for people receiving placebo or paracetamol, except that transient elevation of blood liver enzyme levels was more frequent during repeated administration of paracetamol to patients with spinal pain (RR, 3.8; 95% CI, 1.9–7.4). Conclusions For most conditions, evidence regarding the effectiveness of paracetamol is insufficient for drawing firm conclusions. Evidence for its efficacy in four conditions was moderate to strong, and there is strong evidence that paracetamol is not effective for reducing acute low back pain. Investigations that evaluate more typical dosing regimens are required. PROSPERO registration CRD42015029282 (prospective).

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“…In addition to myocardial infarction and myocardial ischemia, postoperative myocardial damage, which is largely caused by intraoperative hypotension, is a significant and underestimated problem. [5] Criteria for myocardial damage are an increase in highly sensitive troponin T (hsTnT) greater than 20 ng/l with or without symptoms of ischemia. Exceptions are cases where the increase in troponin is associated with other non-cardiac causes (sepsis, pulmonary embolism).…”

Section: Introductionmentioning

confidence: 99%

The effect of anesthesia on the risk of postoperative myocardial injury in elderly patients with hip fracture: randomized controlled trial

Kuchyn

Tokar²,

Бєлка

et al. 2021

SR:MS

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Hip fractures are a common pathology among patients older 50 years and cause disability, reduced duration and quality of life, even with adequate management and surgery. In the perioperative period, the most common complications leading to the death of patients are cardiovascular disease. about a hip fracture. The aim of our study was to determine the safest method of anesthesia in the context of acute myocardial injury during hip fracture surgery. The objectives of the study were to determine the frequency of postoperative myocardial damage in patients with hip fractures; compare the frequency of MINS with different types of anesthesia: general anesthesia (GA), spinal anesthesia (SA) and compartment psoas block with sciatic nerve block. Materials and methods. Randomized controlled trial was conducted from January 2018 to August 2019 in the medical center “Into-Sana” (Odessa, Ukraine). Patients with planned osteosynthesis of the proximal femur were randomized into 3 groups depending on the method of anesthesia: general anesthesia and postoperative systemic analgesia, spinal anesthesia and postoperative systemic analgesia, prolonged compartment psoas block with sciatic nerve block. Results. The study involved 90 patients. Acute postoperative myocardial injury was diagnosed in 17.6 % of cases. Postoperative elevation of troponins was significantly more often diagnosed in groups of patients with spinal anesthesia and general anesthesia compared to the group in which the psoas block compartment was used in combination with the sciatic nerve block. None of the patients had symptoms of myocardial ischemia and were not diagnosed with myocardial infarction. Hypotension was significantly more common in group 2 spinal anesthesia (OR 9 95 % CI 1.9-47, p=0.004) There was a direct moderate association between the intraoperative hypotension and the development of postoperative myocardial injury (r = 0.5). Conclusions. Prolonged compartment psoas block with sciatic nerve block intraoperatively is the safest method of anesthesia in the context of the development of postoperative myocardial injury. Intraoperative hypotension is associated with postoperative myocardial injury

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Assessment and Early Management of Pain in Hip Fractures: The Impact of Paracetamol

Cited by 31 publications

References 38 publications

Nutrition in Hip Fracture Units: Contemporary Practices in Preoperative Supplementation

Nutrition in Hip Fracture Units: Contemporary Practices in Preoperative Supplementation

The efficacy and safety of paracetamol for pain relief: an overview of systematic reviews

The effect of anesthesia on the risk of postoperative myocardial injury in elderly patients with hip fracture: randomized controlled trial

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