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Abstract
BACKGROUND To assess the effect of fascia iliaca compartment block (FICB) on pain control and morphine consumption in patients with hip fracture. METHODS We searched databases (PubMed, Embase, Cochrane Library) for eligible randomized controlled trials (RCTs) published prior to September 12, 2018. We only included hip fracture patients who received FICB versus placebo for pain control. Risk ratios (RRs), standard mean differences (SMD) and 95% confidence intervals (CI) were determined. Stata 12.0 was used for the meta-analysis. RESULTS Eleven trials involving 937 patients underwent hip fracture were retrieved. FICB significantly decreased the pain intensity at 1-8 h (SMD = -1.03, 95% CI [-1.48, -0.58], P = .000), 12 h (SMD = -1.06, 95% CI [-1.36, -0.75], P = .000), 24 h (SMD = -1.14, 95% CI [-1.66, -0.62], P = .000) and 48 h (SMD = -0.96, 95% CI [-1.33, -0.60], P = .000). Moreover, FICB could reduced the total morphine consumption and the occurrence of nausea (P < .05). There was no significant difference between the pain intensity at 72 h (SMD = 0.11, 95% CI [-0.12, 0.34], P = .355). CONCLUSIONS FICB has a beneficial role in reducing pain intensity and morphine consumption after hip fracture. Moreover, FICB has morphine-sparing effects when compared with a control group. More high-quality RCTs are needed to identify the optimal technique and volume of injectate for FICB.
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Ma Y, Wu J, Xue J, Lan F, Wang T. Ultrasound-guided continuous fascia iliaca compartment block for pre-operative pain control in very elderly patients with hip fracture: A randomized controlled trial. Exp Ther Med 2018; 16:1944-1952. [PMID: 30186422 PMCID: PMC6122427 DOI: 10.3892/etm.2018.6417] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 06/01/2018] [Indexed: 12/19/2022] Open
Abstract
The present study presented the results of a prospective, randomized controlled trial. The present study enrolled 98 very elderly patients with hip fractures, complicated with at least one cardiovascular, neurological or pulmonary disease, of whom 10 patients were excluded. A total of 88 patients were randomly assigned into 2 groups: i) The control group, receiving traditional analgesia including 50 mg Tramadol and 500 mg paracetamol orally three times a day from admission to surgery; and ii) the study group, receiving ultrasound-guided continuous fascia iliaca compartment block (CFICB), a single 50 ml 0.4% ropivacaine injection with continuous infusion of 0.2% ropivacaine at a dose of 5 ml/h from admission to surgery. The primary outcome measure of pain relief or pain intensity was assessed preoperatively and up to 48 h postoperatively using a visual analog scale (VAS). The results of the present study indicated that in the preoperative period, in the morning of the day of surgery, the VAS pain at rest scores were lower in the study group compared with the control group (P=0.023). The VAS passive movement scores of the study group were also significantly lower compared with the control group 1 h following analgesia at the time of admission (P<0.05) and in the morning of the day of surgery (P<0.05). Scores for patients' satisfaction with the analgesic regimen in the preoperative period were greater in the study group compared with the control group (P<0.001). There was no difference in analgesia-associated side effects between groups. Duration of hospital stay of patients in the control group was significantly longer compared with the study group (P=0.001). Patients in the study group were less likely to have increased complications compared with patients in the control group over the N2-N4 period (from preoperative period to after surgery; P=0.016). The present study concluded that ultrasound guided CFICB was an effective method of providing analgesia for very elderly (≥80 years old) with hip fracture.
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Affiliation(s)
- Yanhui Ma
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Jie Wu
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Jixiu Xue
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Fei Lan
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
| | - Tianlong Wang
- Department of Anesthesiology, Xuanwu Hospital, Capital Medical University, Beijing 100053, P.R. China
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Kacha NJ, Jadeja CA, Patel PJ, Chaudhari HB, Jivani JR, Pithadia VS. Comparative Study for Evaluating Efficacy of Fascia Iliaca Compartment Block for Alleviating Pain of Positioning for Spinal Anesthesia in Patients with Hip and Proximal Femur Fractures. Indian J Orthop 2018; 52:147-153. [PMID: 29576642 PMCID: PMC5858208 DOI: 10.4103/ortho.ijortho_298_16] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patient positioning for performing spinal blockade causes severe pain in hip and femur fracture. Adequate pain relief before administrating spinal blockade will increase patient's cooperation. This study was done to assess analgesic effect of fascia iliaca compartment block (FICB) for positioning for spinal anesthesia. MATERIALS AND METHODS This was a randomized, double blind, controlled prospective study that included 100 patients of the American Society of Anesthesiologists physical statuses I to III, of either sex, between 30 and 90 years, posted for hip or proximal femoral surgery, with visual analogue scale (VAS) >3 in preoperative period. The two groups were assigned randomly. In Group 1, FICB was given half an hour before shifting the patients in operation theater with 30 ml of 0.25% ropivacaine, and in Group 2, sham block was given with 30 ml normal saline. Each group included 50 patients. Thirty minutes after FICB, spinal anesthesia was given and patients' vitals were monitored before and after block, at the time of positioning for spinal anesthesia, intraoperative and postoperative periods. RESULTS In Group 1, mean VAS before FICB was 8.02 which reduced to 2.28, which is statistically significant (P = 7.8813E-50), whereas in Group 2, mean VAS before sham block was 7.98 which reduced to 7.90, which is statistically nonsignificant (P = 0.6694). Mean total duration of analgesia in Group 1 was 428.3 min after spinal anesthesia, whereas in Group 2, mean total duration of analgesia was 240.1 min. CONCLUSION FICB effectively provides analgesia for positioning for spinal anesthesia to patients in hip and proximal femur surgeries. It also provides analgesia in postoperative period without having significant alteration in the hemodynamic profile of patients.
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Affiliation(s)
- Nirav Jentilal Kacha
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India,Address for correspondence: Dr. Nirav Jentilal Kacha, 301, Block A, New P. G. Hostel, P. D. U. Medical College, Near RUDA Office, Jamnagar Road, Rajkot - 360 005, Gujarat, India. E-mail:
| | - Chetna A Jadeja
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India
| | - Pooja J Patel
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India
| | - Harshda B Chaudhari
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India
| | - Jatin R Jivani
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India
| | - Vandana S Pithadia
- Department of Anesthesiology, P. D. U. Medical College, Rajkot, Gujarat, India
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Zhang P, He J, Fang Y, Chen P, Liang Y, Wang J. Efficacy and safety of intravenous tranexamic acid administration in patients undergoing hip fracture surgery for hemostasis: A meta-analysis. Medicine (Baltimore) 2017; 96:e6940. [PMID: 28538384 PMCID: PMC5457864 DOI: 10.1097/md.0000000000006940] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Patients undergoing hip fracture surgery frequently require blood transfusion. Tranexamic acid (TXA) has been widely used to decrease blood loss and transfusion rates in joint replacement surgery. Therefore, we conducted a meta-analysis to evaluate efficacy and safety of intravenous TXA administration in patients suffering from hip fractures. METHODS Electronic databases were searched before December 2016 by 2 independent reviewers, including Cochrane Library, EMBASE, PubMed, Web of Science, the Chinese Biomedical Literature database, and the China National Knowledge Infrastructure databases. Randomized controlled trials (RCTs) involving the efficacy and safety of intravenous (IV) TXA in patients who underwent hip surgery were included in our meta-analysis. The endpoints included total blood loss, hidden blood loss, postoperative hemoglobin decline, transfusion rates, the rate of thrombotic events, and operative time. Current meta-analysis was performed following the guidelines of the Cochrane Reviewer's Handbook and the PRISMA statement. The pooling of data was carried out using STATA V.12.0 software. RESULT Eight RCTs were included, involving 598 participants. Current meta-analysis indicated that the IV TXA group had less total blood loss (weighted mean difference [WMD] = -277, 95%CI: -335 to -220, P = .000), less hidden blood loss (WMD = -246, 95%CI: -252 to -241, P = .000), lower postoperative hemoglobin decline (WMD = -1.36, 95% CI: -1.84 to -0.88, P = .000), and lower transfusion rates (risk difference [RD] = -0.19, 95% CI: -0.27 to -0.11, P = .000) compared to the control group. No significant differences were found regarding the rate of thrombotic events (RD = 0.02, 95% CI: = -0.01 to 0.05, P = .262) and operative time (WMD = -0.7, 95% CI: -3.3 to 1.9, P = .6). CONCLUSION It was well established that systemic administration of TXA could reduce blood loss and transfusion rates in hip fracture surgery. But the optimal regimen, dosage, and timing still need a further research. In addition, more large and high-quality randomized controlled studies are needed to focus on the safety of IV TXA application before its wide recommendation for use in hip fracture surgery.
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Affiliation(s)
- Pei Zhang
- Dalian Medical University, Dalian, Liaoning, China
| | - Jinshan He
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China
| | - Yongchao Fang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China
| | - Pengtao Chen
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China
| | - Yuan Liang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China
| | - Jingcheng Wang
- Department of Orthopedics, Clinical Medical College of Yangzhou University, Subei People's Hospital, Yangzhou, China
- Dalian Medical University, Dalian, Liaoning, China
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Berthelsen CB, Hølge-Hazelton B. Orthopaedic nurses' attitudes towards clinical nursing research – A cross-sectional survey. Int J Orthop Trauma Nurs 2015; 19:74-84. [DOI: 10.1016/j.ijotn.2014.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Revised: 09/29/2014] [Accepted: 10/14/2014] [Indexed: 11/16/2022]
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Improving the experience of hip fracture care: A multidisciplinary collaborative approach to implementing evidence-based, person-centred practice. Int J Orthop Trauma Nurs 2015; 19:24-35. [DOI: 10.1016/j.ijotn.2014.03.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 03/26/2014] [Accepted: 03/31/2014] [Indexed: 12/21/2022]
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Wagner JIJ, Warren S, Cummings G, Smith DL, Olson JK. Workplace model for physical therapists and occupational therapists. J Health Organ Manag 2014; 28:290-314. [PMID: 25080646 DOI: 10.1108/jhom-04-2012-0070] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this paper is to test a model linking physical therapy (PT) and occupational therapy (OT) practitioners' perceptions of resonant leadership, structural empowerment and psychological empowerment to their experiences of spirit at work (SAW), job satisfaction and organizational commitment within the Canadian workplace. DESIGN/METHODOLOGY/APPROACH The authors tested the model using LISREL 8.80 and survey data from 101 OTs and 169 PTs, randomly selected by the Alberta professional licensing associations. Content analysis of responses to the open-ended comments section provided additional depth and insight. FINDINGS Analysis of results culminated in minor modifications to the original theoretical model, creating separate PT and OT models. Both models revealed a good fit with the observed data. Several SAW concepts accounted for moderate to large amounts of variance in both PT and OT models, indicating that SAW is a comprehensive workplace outcome. RESEARCH LIMITATIONS/IMPLICATIONS Theory was derived from business and nursing research literature due to limited rehabilitation research literature. Discussion of OT results must consider the small sample size. This study is initial exploratory research. PRACTICAL IMPLICATIONS Each discipline-specific model provides professionals, health care leaders and policy makers with a rich body of information upon which to base beneficial workplace decisions. SAW will guide leaders in the holistic development and enrichment of the work environment. ORIGINALITY/VALUE This research contributes to the substantive knowledge of the OT and PT disciplines, particularly in the areas of leadership, workplace structural organization and indicators of healthy work environments such as SAW, empowerment, job satisfaction and organizational commitment.
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Collinge CA, McWilliam-Ross K, Beltran MJ, Weaver T. Measures of clinical outcome before, during, and after implementation of a comprehensive geriatric hip fracture program: is there a learning curve? J Orthop Trauma 2013; 27:672-6. [PMID: 23515124 DOI: 10.1097/bot.0b013e318291f0e5] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the effects of implementing a multidisciplinary geriatric hip fracture program on clinical outcome measures at our institution. DESIGN Retrospective comparative cohort study of consecutive patients treated before, during, and after implementation of this program, including patient data from electronic medical records and state death records. SETTING Single metropolitan level 2 regional trauma center and community hospital. PATIENTS/PARTICIPANTS Patients aged 60 years and older with operatively treated low-energy hip fractures were included. Patients with active cancer or a high-energy mechanism (motor vehicle crash or fall >3 ft) were excluded. INTERVENTION Patients were divided into 1 of 3 groups: (1) those treated before our hip fracture program (July 2008-April 2009), (2) during implementation of the hip fracture program (May 2009-Feb 2010), and (3) after the hip fracture program was instituted and participation was well established (March 2010-Dec 2010). MAIN OUTCOME MEASURES Patient demographics, injury factors, and clinical outcomes, including performance measures (eg, time to medical clearance and surgery and length of stay) and patient deaths (in-hospital, 30 days, and 1 year), were compared. RESULTS There was significant improvement in clinical performance measures, including time to surgery and length of stay during and after implementation of our geriatric hip fracture program. The in-hospital mortality rate increased during the implementation phase of this program (P = 0.04). Once established, however, the in-hospital mortality decreased to a more typical level. Thirty-day and 1-year mortality rates were not significantly different among the 3 groups. CONCLUSIONS Most clinical outcome measures improved significantly with implementation of our geriatric hip fracture program. Increased in-hospital mortality, however, was an unintended consequence seen while establishing this program and may represent a learning curve by health care providers. Patient demise in the longer term seemed to be unaffected by implementation of the program. LEVEL OF EVIDENCE Therapeutic level III.
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Affiliation(s)
- Cory A Collinge
- *Texas Health Harris Methodist Hospital Fort Worth; Fort Worth, TX; †Orthopaedic Surgery Residency Program, John Peter Smith Hospital, Fort Worth, TX; ‡San Antonio Military Medical Center, San Antonio, TX; and §Orthopedic Specialty Associates, Fort Worth, TX
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Dulaney-Cripe E, Hadaway S, Bauman R, Trame C, Smith C, Sillaman B, Laughlin R. A continuous infusion fascia iliaca compartment block in hip fracture patients: a pilot study. J Clin Med Res 2012; 4:45-8. [PMID: 22383926 PMCID: PMC3279500 DOI: 10.4021/jocmr724w] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2011] [Indexed: 11/15/2022] Open
Abstract
Background Hip fractures account for 350,000 fractures annually and the projected incidence is expected to exceed 6.3 million by 2050. As the number of hip fractures continues to increase as a result of the aging American population, the importance of limiting and preventing complications is magnified. Methods This study demonstrated the clinical effects of a continuous fascia iliaca compartment block placed pre-operatively when combined with a comprehensive pain protocol. All patients who presented to our institution with a hip fracture were given the option of having a continuous fascia iliaca compartment block for pain control versus usual pain management (non-opioids, opioids, and ice therapy). The block was monitored by the pain service until the day of discharge from the hospital. Data was collected regarding mean pain scores, average length of stay and opioid medication use. Results There were eighteen males and twenty four females. The pain score on post-operative day zero was reduced from a 2010 annual average of 4.1 to 1.7 in the pilot study group on the visual analog score. On post-operative day one, the 2010 annual average was 2.9 compared to 1.4 in the pilot study group. The length of stay was decreased from the 2010 annual average of 5.9 days to 4.8 days in the pilot study group. The patients used an average of 18mg of morphine equivalent medications during the average infusion time of 40.7 hours. There were no falls or infections noted within our pilot study group. Conclusions Overall, it has been noticed that the reduction in opioid usage in this elderly patient population, with an average age of seventy five years, has produced alert and mobile patients often as early as post-operative day one. The length of stay has decreased along with the average pain score in the pilot sample of forty two patients. Keywords Hip fracture; Fascia Iliaca Compartment Block; Pain Score
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Alrwaily M, Whitney SL. Vestibular rehabilitation of older adults with dizziness. Otolaryngol Clin North Am 2011; 44:473-96, x. [PMID: 21474018 DOI: 10.1016/j.otc.2011.01.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
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Affiliation(s)
- Muhammad Alrwaily
- Department of Physical Therapy, University of Pittsburgh, 6035 Forbes Tower, Pittsburgh, PA 15260, USA
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Friedman SM, Mendelson DA, Kates SL, McCann RM. Geriatric Co-Management of Proximal Femur Fractures: Total Quality Management and Protocol-Driven Care Result in Better Outcomes for a Frail Patient Population. J Am Geriatr Soc 2008; 56:1349-56. [DOI: 10.1111/j.1532-5415.2008.01770.x] [Citation(s) in RCA: 241] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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