scholarly journals P076: Delirium prevention in the emergency department using regional anesthesia with ultrasound guidance in the elderly population with hip fracture: a pilot study

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S103-S104 ◽  
Author(s):  
P. LeBlanc ◽  
V. Boucher ◽  
M. Émond ◽  
J. Courtemanche ◽  
M. Ménassa ◽  
...  
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Pilot Study ◽  
Regional Anesthesia ◽  
Pain Control ◽  
Elderly Population ◽  
The Elderly ◽  
Pain Reduction ◽  
Quebec City ◽  
Emergency Doctors

Introduction: The incidence of delirium following hip fracture is near 60%. The use of regional anesthesia (RA) with ultrasound (U/S) guidance has suggested a decrease in delirium incidence. In this pilot study, we propose to include the use of femoral block with U/S guidance in the management of the elderly population with hip fracture in the emergency department (ED) to lower the risk of delirium. Methods: This paired control case study was conducted from December 2013 to April 2015, and includes patients seen by emergency doctors from the ED of Hospital Enfant Jesus in Quebec City. Patients of the intervention and control groups were paired by age. Inclusion Criteria: Patients with(1) a hip fracture; (2) admitted to the hospital after their ED management; (3) and surgically repaired. Exclusion Criteria: Patients (1) with delirium upon arrival or a known mental/cognitive status (dementia, unconsciousness or severely ill status) (2) less than 60 years old (3) not able to speak English or French. Intervention group: Patients with hip fracture who received femoral blocks by the five emergency doctors who were trained and performed with U/S guidance. Control group: Patients with hip fracture who received standard pain control care by emergency doctors and who did not receive a femoral block. Analysis: Incidence of delirium and blocks performed by EM doctors were tallied. A comparison of absolute pain reduction at 30 minutes was also done. Odd ratios were derived and adjusted for age, sex, total opiates dose, delay before surgery and morbidity scores. Results: A total of 29 femoral blocks were performed through the analysis period. Groups were similar for age, sex and APACHE II and CHARLSON scores. A 30 minutes absolute pain reduction of 3/10 was noted. Two thirds of the blocks were performed by two ED doctors. Need for rescue medication was needed for 7% of patients for pain control at 30 minutes. Adjusted odd ratios for age, sex, morbidity scores, total opiate doses and delay before surgery revealed no decrease in delirium. Conclusion: Ten out of 26 patients hospitalized for hip fracture who received a femoral block under U/S guidance from the ED doctors were diagnosed with delirium. A Canadian prospective study «EDURAPID» is underway to demonstrate more the impact of R/A under U/S guidance on the incidence de delirium in this population.

scholarly journals Perioperative Multimodal Anesthesia Using Regional Techniques in the Aging Surgical Patient

2014 ◽  
Vol 2014 ◽  
pp. 1-13 ◽  
Author(s):  
Diana Nordquist ◽  
Thomas M. Halaszynski
Keyword(s):  
Drug Therapy ◽  
Adverse Effects ◽  
Elderly Patients ◽  
Regional Anesthesia ◽  
Pain Control ◽  
The Elderly ◽  
Surgical Patient ◽  
Cochrane Central Register ◽  
Promising Alternative ◽  
Age Related

Background. Elderly patients have unique age-related comorbidities that may lead to an increase in postoperative complications involving neurological, pulmonary, cardiac, and endocrine systems. There has been an increase in the number of elderly patients undergoing surgery as this portion of the population is increasing in numbers. Despite advances in perioperative anesthesia and analgesia along with improved delivery systems, monotherapy with opioids continues to be the mainstay for treatment of postop pain. Reliance on only opioids can oftentimes lead to inadequate pain control or increase in the incidence of adverse events. Multimodal analgesia incorporating regional anesthesia is a promising alternative that may reduce needs for high doses and dependence on opioids along with any potential associated adverse effects. Methods. The following databases were searched for relevant published trials: Cochrane Central Register of Controlled Trials and PubMed. Textbooks and meeting supplements were also utilized. The authors assessed trial quality and extracted data. Conclusions. Multimodal drug therapy and perioperative regional techniques can be very effective to perioperative pain management in the elderly. Regional anesthesia as part of multimodal perioperative treatment can often reduce postoperative neurological, pulmonary, cardiac, and endocrine complications. Regional anesthesia/analgesia has not been proven to improve long-term morbidity but does benefit immediate postoperative pain control. In addition, multimodal drug therapy utilizes a variety of nonopioid analgesic medications in order to minimize dosages and adverse effects from opioids while maximizing analgesic effect and benefit.

PPARG gene promoter polymorphism is associated with non-traumatic hip fracture risk in the elderly Slovenian population: A pilot study

2011 ◽  
Vol 44 (13) ◽  
pp. 1085-1089 ◽  
Author(s):  
Jana Dragojevič ◽  
Barbara Ostanek ◽  
Simona Mencej-Bedrač ◽  
Radko Komadina ◽  
Janez Preželj ◽  
...  
Keyword(s):  
Hip Fracture ◽  
Pilot Study ◽  
Fracture Risk ◽  
Gene Promoter ◽  
The Elderly ◽  
Promoter Polymorphism ◽  
Hip Fracture Risk ◽  
Slovenian Population ◽  
Pparg Gene ◽  
Gene Promoter Polymorphism

A comparison between Right Unilateral Ultrabrief electroconvulsive therapy and bilateral electroconvulsive therapy in the elderly: a pilot naturalistic observational study

2018 ◽  
Vol 26 (4) ◽  
pp. 394-397
Author(s):  
Shalini Narchal ◽  
Anthony WF Harris ◽  
Bruce Allen
Keyword(s):  
Pilot Study ◽  
Adverse Effects ◽  
Observational Study ◽  
Elderly Patients ◽  
Electroconvulsive Therapy ◽  
Clinical Characteristics ◽  
Elderly Population ◽  
The Elderly ◽  
Tertiary Referral ◽  
Tertiary Referral Hospital

Objectives: To compare clinical outcomes and adverse effects between Bitemporal (BT) and Right Unilateral Ultrabrief (RUL(UB)) electroconvulsive therapy (ECT) in an elderly population. Methods: Patients over the age of 65 years admitted to a tertiary referral hospital over a seven month period requiring ECT received RUL(UB) ECT. They were compared with those who received BT ECT over these and the preceding seven months. Results: Twenty-three patients entered the study. No significant differences was observed between the groups in demographic and clinical characteristics or clinical improvement. However, patients who received BT ECT were significantly more likely to be confused post treatment compared with the RUL(UB) group. Conclusions: This pilot study found RUL(UB) ECT to be an effective treatment in elderly patients. These patients also suffered significantly less confusion than patients who received BT ECT.

scholarly journals Comfort of the hospitalized elderly

2018 ◽  
Vol 8 (10) ◽  
pp. 86
Author(s):  
Teresa Silveira ◽  
Raquel Pereira ◽  
Carla Colaço ◽  
Rita Marques ◽  
Patrícia Pontífice-Sousa
Keyword(s):  
Pilot Study ◽  
Nursing Students ◽  
Elderly Population ◽  
Well Being ◽  
The Elderly ◽  
Qualitative Approach ◽  
Central Theme ◽  
Elderly Individuals ◽  
Hospitalized Elderly ◽  
Structured Audio

The purpose of this pilot study is to identify the specifics of comfort in the hospitalized elderly population. This is a descriptive-exploratory pilot study, with a qualitative approach. Data was collected between January and February 2018, being included 12 elderly participants hospitalized in the pulmonology/oncology department. Semi-structured audio-recorded interviews were conducted to obtain the data. The central theme of the comfort phenomenon for the hospitalized elderly individuals comprises four categories that represent the perceptions of the subjects, namely: needs that were felt/experience’s context; intervenients’ role/experience’s context; ways and means of causing comfort/discomfort; attributes associated with the concept of comfort/discomfort. The analysis of each of these categories showed the importance of developing skills, in order to satisfy the comfort needs of the hospitalized elderly. The elderly constitute a group which is socially more vulnerable and fragile. For this reason, nurses and students should be available to provide relief, well-being and comfort to this population with specific needs. The findings of this study reinforce the results of previous research efforts, highlighting categories and subcategories that allow to achieve a balance between needs, expectations and wishes, and an integrated comforting care that should be considered and object of deep research by nursing students.

scholarly journals MP033: The use of femoral nerve blocks in the emergency department for hip fracture patients

CJEM ◽  
2016 ◽  
Vol 18 (S1) ◽  
pp. S77-S77
Author(s):  
A. Sandre ◽  
C. Thompson ◽  
S.L. McLeod ◽  
B. Borgundvaag
Keyword(s):  
Emergency Department ◽  
Hip Fracture ◽  
Regional Anesthesia ◽  
Management Strategy ◽  
Femoral Nerve ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Emergency Physicians ◽  
Nerve Blocks ◽  
Pain Management Strategy

Introduction: Hip fractures affect over 30,000 Canadians each year. Delirium, or acute confusion, occurs in up to 62% of patients following a hip fracture. Delirium substantially increases hospital length of stay and doubles the risk of nursing home admissions and death. Previous studies have shown that regional anesthesia is the optimal pain management strategy for hip fracture patients and has been shown to independently reduce the rate, severity and duration of delirium. However, very few emergency physicians (EPs) have the necessary training and experience to use regional anesthesia for hip fracture in the emergency department (ED). The objective of this study was to determine the number of femoral nerve blocks performed within the ED for the management of hip fracture patients. Methods: This was a retrospective chart review of patients aged 65 years and older, presenting to an academic ED (annual census 60,000) with a discharge diagnosis of hip fracture from January 1st 2014 to July 31st 2015. Results: Of the 243 hip fractures included in this study, mean (SD) age was 82.9 (8.2) years and 187 (77.0%) were female. The majority (214, 88.1%) of patients arrived to the ED by ambulance and 182 (74.9%) were categorized as CTAS 3. The most common analgesics used in the ED were intravenous (IV) hydromorphone (51.4%), IV morphine (32.1%), or dual therapy with both IV hydromorphone and IV morphine (4.9%). Femoral nerve blocks were initiated for 13 (5.3%) patients and successfully completed in 12 (4.9%) patients in the ED. Median (IQR) ED and hospital length of stay was 5.0 (3.7, 6.6) hours and 6.0 (4.1, 10.2) days, respectively. Forty-three (17.7%) patients experienced in-hospital acute delirium. Conclusion: Despite evidence to suggest regional anesthesia may be the optimal pain management strategy for hip fracture patients, the use of femoral nerve blocks in the ED remains low. Future research should attempt to elucidate barriers to use of this procedure by emergency physicians.

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