Prehospital Pain and Analgesic Therapy in Elderly Patients with Hip Fractures

Oberkircher, Ludwig; Schubert, Natalie; Eschbach, Daphne-Asimenia; Bliemel, Christopher; Krueger, Antonio; Ruchholtz, Steffen; Buecking, Benjamin

doi:10.1111/papr.12299

Cited by 15 publications

(21 citation statements)

References 24 publications

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“…Oberkirche et al found that 72% of patients received no prehospital analgesia, despite all of the patients in the study reporting significant pain at first assessment. 24 …”

Section: Resultsmentioning

confidence: 99%

“…High levels of early pain correlate with increased complications, possibly due to immobilization as a result of pain. 24 …”

Section: Resultsmentioning

confidence: 99%

“…We have highlighted the need for a properly controlled stratified trial of preadmission IVP, given the independently demonstrated benefits of both IVP and preadmission paracetamol. 12 , 22 , 24 , 41 The importance of a properly controlled trial (in which all of the previously mentioned variables can be more tightly matched and controlled) is thrown into greater context by the established size of the problem as we have discussed, both to the patient group and the health systems looking after them. Many significant advantages have been identified for the use of IVP compared to oral paracetamol.…”

Section: Discussionmentioning

confidence: 99%

“… 37 , 38 Additionally, administration of oral paracetamol prehospital improves pain management and reduces pain at point of admission. 24 A potential for the improvement of pain management by the administration of IVP prehospital has therefore been identified as an emergent theme from review of the current literature.…”

Section: Discussionmentioning

confidence: 99%

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

Dixon

Ashton

Baker

et al. 2018

Geriatr Orthop Surg Rehabil

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Introduction:As the number of patients sustaining hip fractures increases, interventions aimed at improving patient comfort and reducing complication burden acquire increased importance. Frailty, cognitive impairment, and difficulty in assessing pain control characterize this population. In order to inform future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is presented.Materials and Methods:Systematic review of preoperative IVP administration in patients presenting with a hip fracture.Results:Intravenous paracetamol is effective in the early management of pain control in the hip fracture population. There is a considerable decrease in use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces length of stay, and lowers mean pain scores. Another significant finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% receiving no prehospital analgesia.Discussion:The potential benefits of IVP as routine in the early management of hip fracture-related pain are clear. Studies of direct comparison between analgesia regimes to inform optimum bundles of analgesic care are sparse. This study highlights the need for properly constructed pathway-driven comparator studies of contemporary analgesia regimes, with IVP as a central feature to optimize pain control and minimize analgesia-related morbidity in this vulnerable population.

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“…Oberkirche et al found that 72% of patients received no prehospital analgesia, despite all of the patients in the study reporting significant pain at first assessment. 24 …”

Section: Resultsmentioning

confidence: 99%

“…High levels of early pain correlate with increased complications, possibly due to immobilization as a result of pain. 24 …”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

Dixon

Ashton

Baker

et al. 2018

Geriatr Orthop Surg Rehabil

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show abstract

“…Most studies have described pilot projects or analysed retrospective data (Häske et al., ). Nevertheless, undertreatment of pain in the prehospital phase seems to be a common problem, although recent studies have shown that prehospital analgesia is not associated with major adverse events (Kanowitz et al., ; Bakkelund et al., ; Oberkircher et al., ). In Germany, other than in a few pilot regions, prehospital analgesia is administered solely by EMS physicians (Häske et al., ).…”

Section: Introductionmentioning

confidence: 99%

Analgesia by telemedically supported paramedics compared with physician‐administered analgesia: A prospective, interventional, multicentre trial

Brokmann

Rossaint

Hirsch

et al. 2016

European Journal of Pain

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Telemedical delegation of analgesics to paramedics was safe and led to a pain reduction superior to the published minimum standard in both groups. The documentation quality was better in the telemedicine group. WHAT DOES THIS STUDY ADD?: Little is known about the safety and quality of prehospital analgesia carried out by emergency medical services (EMS). Beside potential quality problems, in some countries meaningful pain reduction is limited by legal regulations that allow only physicians to administer analgesics. This first multicentre prospective trial for telemedically delegated analgesia demonstrates that remote analgesia is possible and safe and retains equivalent analgesic quality compared with that administered by onsite EMS physicians.

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Orthopedic injuries

Mercer¹

2021

Emergency Medical Services

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Prehospital Pain and Analgesic Therapy in Elderly Patients with Hip Fractures

Abstract: Only a minority of patients with hip fractures received prehospital analgesia. The administration of prehospital analgesia was associated with significant pain relief.

Cited by 15 publications

References 24 publications

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

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

Analgesia by telemedically supported paramedics compared with physician‐administered analgesia: A prospective, interventional, multicentre trial

Orthopedic injuries

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