Early recovery of basic mobility under femoral nerve block after hip fracture surgery - A propensity score matched pilot study.

Aged, 80 and over Femoral Nerve Hip Fractures / surgery Humans Nerve Block Pain, Postoperative / drug therapy Pilot Projects Propensity Score
CAS Cumulated ambulation score Dementia Hip fracture Nerve block Physical function Regional anesthesia

Journal

Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040

Informations de publication

Date de publication:
Nov 2021
Historique:
received: 29 01 2021
revised: 15 07 2021
accepted: 16 07 2021
pubmed: 5 8 2021
medline: 10 11 2021
entrez: 4 8 2021
Statut: ppublish

Résumé

Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia. A total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type. Patients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia. Patients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.

Sections du résumé

BACKGROUND BACKGROUND
Previous studies have shown better pain reduction utilizing femoral nerve block (FNB) in patients who underwent hip fracture surgery. However, few studies have focused on the recovery of physical function after FNB, and most studies excluded patients with dementia. We investigated the association between FNB performed in the operating room and the recovery of physical function after hip fracture surgery, including patients with dementia.
METHODS METHODS
A total of 103 patients with a mean age of 87.4 years who underwent hip fracture surgery under spinal anesthesia between July 2015 and December 2017 (46 patients receiving a single injection of FNB and 57 standard care) were enrolled. Patients with FNB versus standard care were matched by a propensity score to adjust for patient characteristics. An anesthesiologist performed FNB with 20ml of 0.2% ropivacaine, and the standard care group received intravenous 1000 mg acetaminophen or 50mg flurbiprofen once after surgery. After matching, 78 patients were analyzed. Our primary outcome was 3-day cumulated ambulation score (CAS, 0-18 points) and secondary outcomes were 1-day CAS on postoperative day 1-3 and length of hospital stay. We also stratified patient groups based on the presence of dementia and fracture type.
RESULTS RESULTS
Patients undergoing FNB had significantly better 3-day CAS compared to standard care (mean [SD], 8.72 [3.42] vs 7.33 [2.62]; mean difference, 1.38 [95%CI; 0.03 - 2.74]; p = 0.048) and 1-day CAS on postoperative day two (mean [SD], 3.10 [1.39] vs 2.56 [0.94]; mean difference, 0.54 [0.01 - 1.07]; p = 0.049). Length of hospital stay did not significantly differ among the two groups (p = 0.65). Larger positive effect was likely to be seen for patients with a femoral neck fractures and for those without dementia.
CONCLUSIONS CONCLUSIONS
Patients who underwent surgery with spinal anesthesia plus FNB had better ambulatory status early after hip fracture surgery compared to patients not offered FNB. The beneficial association between FNB and ambulatory status was likely to be observed especially in patients with femoral neck fracture and without dementia.

Identifiants

DOI: 10.1016/j.injury.2021.07.028 PMID: 34344517
pubmed: 34344517
pii: S0020-1383(21)00633-1
doi: 10.1016/j.injury.2021.07.028
pii:
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

3382-3387

Informations de copyright

Copyright © 2021 Elsevier Ltd. All rights reserved.

Auteurs

Takahisa Ogawa (T)

Department of Orthopedic Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-8503, Japan; Department of Orthopedic Surgery, Tokyo Medical and Dental University, Tokyo, Japan. Electronic address: takahisa.o@gmail.com.

Keiko Seki (K)

Department of Anestheology, Suwa Central Hospital, Nagano, Japan.

Tetsuya Tachibana (T)

Second Department of Orthopedic Surgery, Dokkyo Medical University, Saitama Medical Center, Saitama, Japan.

Hiroto Hayashi (H)

Department of Public Health in Global Health, Graduate School of Medicine, Tokyo Medical and Dental University, Japan.

Janelle Moross (J)

Office for Global Education and Career Development, International Exchange Center, Tokyo Medical and Dental University, Japan. Electronic address: jmoross.isc@tmd.ac.jp.

Morten Tange Kristensen (MT)

Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Departments of Physiotherapy and Orthopaedic Surgery, Copenhagen University Hospital Amager-Hvidovre & Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.

Shinichi Shirasawa (S)

Department of Orthopedic Surgery, Suwa Central Hospital, 4300 Tamagawa, Chino, Nagano 391-8503, Japan. Electronic address: sshirasawa@aol.com.

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Classifications MeSH

questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Sujet âgé › Sujet âgé de 80 ans ou plus › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Système nerveux › Système nerveux périphérique › Nerfs périphériques › Nerfs spinaux › Plexus lombosacral › Nerf fémoral › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Plaies et blessures › Traumatismes de la jambe › Fractures du fémur › Fractures de la hanche › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures de neurochirurgie › Dénervation › Bloc nerveux › Early recovery of basic mobility under femoral...
questionsmedicales.fr › États, signes et symptômes pathologiques › Signes et symptômes › Manifestations neurologiques › Douleur postopératoire › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Projets pilotes › Early recovery of basic mobility under femoral...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Score de propension › Early recovery of basic mobility under femoral...