Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture – a randomized controlled trial

Scheinin, Harry; Virtanen, T; Kentala, Erna; Uotila, Pekka; Laitio, Timo; Hartiala, Jaakko; Heikkilä, Heikki; Sariola-Heinonen, K; Pullisaar, Olar; Yli‐Mäyry, Sinikka; Jalonen, J.

doi:10.1034/j.1399-6576.2000.440905.x

Cited by 64 publications

(49 citation statements)

References 40 publications

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“…Overall, 1 (5%) RCT 15 was assessed as low risk of bias, 9 (43%) 14,[16][17][18][19][20][21][22][23] had high risk of bias, and the remaining 11 (52%) 13,[24][25][26][27][28][29][30][31][32][33] The Table lists key characteristics of the eligible studies. They were published from 1991 to 2010 and ranged in size from 14-209 participants.…”

Section: Resultsmentioning

confidence: 99%

“…We were able to compare acute pain intensity between seven nerve block strategies using data from 16 studies comprising 1,089 subjects. In 15 studies, pain was measured on a 10-cm visual analogue scale or an 11-point numeric rating scale, 13,16,17,[20][21][22][23][24][25]27,28,[30][31][32][33] and in one study, a four-point verbal rating scale was used. 18 Pain was also measured at a variety of intervals (ranging from hourly to daily).…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Efficacité d’un bloc nerveux périphérique supplémentaire pour les chirurgies de fracture de la hanche: Comparaison de plusieurs traitements

Rashiq

Vandermeer

Abou‐Setta

et al. 2013

Can J Anesth/J Can Anesth

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Efficacité d’un bloc nerveux périphérique supplémentaire pour les chirurgies de fracture de la hanche: Comparaison de plusieurs traitements

Rashiq

Vandermeer

Abou‐Setta

et al. 2013

Can J Anesth/J Can Anesth

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“…Studies have suggested that epidural anesthesia instituted preoperatively reduces perioperative myocardial ischemia more effectively than does the use of parenteral narcotics. 48,49 Currently, there is insufficient evidence to determine if the use of nerve blocks for postoperative analgesia confers any substantial benefit compared with other analgesic methods. 50 The control of postoperative pain is important in preventing delirium.…”

Section: Postoperative Considerationsmentioning

confidence: 99%

A Guide to Improving the Care of Patients With Fragility Fractures

Bukata

DiGiovanni

Friedman

et al. 2011

Geriatr Orthop Surg Rehabil

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ForewordFragility fractures, low-energy injuries that occur from a fall from a standing or lower height, represent a serious public health problem. After age 50, the lifetime risk of having a fragility fracture is 33% for an American woman and 20% for a man. 1 In the United States, 2.1 million people will suffer a fragility fracture each year.1 The incidence of fragility fractures increases steeply after age 65.2 Osteoporosis is present in most patients with a fragility fracture.Hip fractures are the most serious in terms of cost and morbidity. The average cost of inpatient care for a hip fracture in 2005 was $33 962.3 The lifetime risk of having a hip fracture is 6% for men and 17.5% for women. Although the mortality risk after a hip fracture is much higher for a man, a woman's risk of dying from a hip fracture is high and exceeds the lifetime risk of death from breast cancer, uterine cancer, and ovarian cancer combined. For those who survive after a hip fracture, most do not regain their preinjury level of function, and 30% lose their independence. This loss of independence is greatly feared by patients and is very costly to patients and society.Although a hip fracture may have the most serious consequences, other bones, such as the wrist, shoulder, ankle, pelvis, and spine, frequently fracture in the osteoporotic patient. For example, the lifetime risk of a forearm or vertebral compression fracture is 16% and 15.6%, respectively, for a woman and 2.5% and 5%, respectively, for a man. 4 These statistics clearly show that fragility fractures are a major problem facing American society today, 5 and the care of such fractures presents an even greater challenge, in part because the quality of care delivered in the United States varies widely, even within one region. Many such fractures are treated in an outpatient setting, although some may be treated in the inpatient hospital setting. However, the quality of care for seniors with fragility fractures receives relatively little attention. In 2004, the United States Surgeon General issued a comprehensive report calling for health professionals to make significant improvements in our nation's bone health, and an improvement in the system and methods of care was suggested. 5There has been little written on the subject of improving the system of care delivery in the United States.The goals of this blue book are to review the methods used in inpatient and outpatient care, as well as rehabilitation of the patient with a fragility fracture. We discuss evidence-based best care models and, where evidence is lacking, present expert opinions in an effort to improve the standard and the quality of care for the patient with a fragility fracture. We hope that this monograph will provide guidance to physicians, nurses, rehabilitation therapists, other health care providers, and administrators.Stephen L. Kates, MD Editor-in-Chief Simon C. Mears, MD, PhD

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“…Une analgésie péridurale a montré la réduction des complications cardiaques ischémiques, rythmiques et de l'insuffisance cardiaque périopératoire [26,27].…”

Section: éValuation Clinique Et Biologique Préopératoireunclassified

Application de l’évaluation gérontologique à la planification d’une intervention chirurgicale: l’exemple de la prise en charge de la fracture de l’extrémité supérieure du fémur

Gbaguidi

Guillou

Quibel

et al. 2009

cah. année gerontol.

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Les fractures de l'extrémité supérieure du fémur (FESF) surviennent chez des patients âgés, le plus souvent fragiles ou polypathologiques. Elles sont responsables d'un taux de mortalité d'environ 25 % à un an et d'une augmentation de la dépendance des sujets dans plus d'un tiers des cas. La qualité de la prise en charge des FESF a pour but d'améliorer la survie, de préserver la qualité de vie et de maintenir l'autonomie fonctionnelle du malade. Une prise en charge multidisciplinaire est alors nécessaire pour parvenir à cet objectif en réduisant le délai séparant la fracture de l'intervention, en dépistant les conditions médicales qui exposent le malade à des complications postopératoires et en planifiant précocement la sortie du malade âgé de l'hôpi-tal. La gestion partagée des patients entre les différents intervenants (médecins anesthésistes, chirurgiens, gériatres, soignants, etc.) est à l'origine d'unités spécialisées d'orthogériatrie. Les protocoles d'interventions pluridisciplinaires basés sur l'évaluation des malades et la mise en place de projets de soins ciblés figurent au premier plan des actions menées dans ces unités.Mots clés Évaluation gériatrique standardisée · Fracture de l'extrémité supérieure du fémur · Orthogériatrie · Mortalité Abstract Hip fracture occurs in old patients who are more often frail and characterized by many comorbidity. The mortality rate (within 12 months) associated with hip fractures is about 25% and about one third of patients are disabled even after surgical repair. The objectives of quality of care for hip fracture management include improvement of survival rates while preserving quality of life and functional independence as well. An interdisciplinary management is necessary to reach these goals. Staffs (including surgeons, anaesthetists, nurses and geriatricians) involve in this clinical pathway have to reduce delay from fracture event to intervention, to detect conditions that may impact on medical complications in postoperative period and to plan discharge early as possible. Models of co-management for treated patients sharing interventions between all these professionals have been developed in specific orthogeriatrics clinics. Comprehensive geriatric assessment of patients contributes to apply specific protocols of care for these frail patients.

show abstract

Epidural infusion of bupivacaine and fentanyl reduces perioperative myocardial ischaemia in elderly patients with hip fracture – a randomized controlled trial

Abstract: Continuous epidural bupivacaine/fentanyl analgesic regimen, started preoperatively, reduces the amount of myocardial ischaemia in elderly patients with hip fracture.

Cited by 64 publications

References 40 publications

Efficacité d’un bloc nerveux périphérique supplémentaire pour les chirurgies de fracture de la hanche: Comparaison de plusieurs traitements

Efficacité d’un bloc nerveux périphérique supplémentaire pour les chirurgies de fracture de la hanche: Comparaison de plusieurs traitements

A Guide to Improving the Care of Patients With Fragility Fractures

Application de l’évaluation gérontologique à la planification d’une intervention chirurgicale: l’exemple de la prise en charge de la fracture de l’extrémité supérieure du fémur

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