title: Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study.
abstract: The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).
authors.affiliation: Department of Health Sciences, Section of Anaesthesia, Intensive Care and Pain Therapy, University of Florence, c/o Careggi Hospital, Largo Brambilla 3, 50124, Florence, Italy, adifilippo07@gmail.com.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Di Filippo
authors.forename: Manuela
authors.initials: M
authors.lastname: Magherini
authors.forename: Peggy
authors.initials: P
authors.lastname: Ruggiano
authors.forename: Antonio
authors.initials: A
authors.lastname: Ciardullo
authors.forename: Silvia
authors.initials: S
authors.lastname: Falsini
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000368:Aged; D000698:Analgesia / Q000379:methods*; D000700:Analgesics / Q000008:administration & dosage / Q000145:classification; D015331:Cohort Studies; D004333:Drug Administration Routes; D004334:Drug Administration Schedule; D005260:Female; D005592:Fracture Fixation / Q000009:adverse effects* / Q000379:methods; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D008297:Male; D009020:Morphine / Q000008:administration & dosage*; D009407:Nerve Block / Q000379:methods; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement / Q000379:methods; D010149:Postoperative Pain / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D013812:Therapeutics
chemical_list: D000700:Analgesics; D000082:Acetaminophen; D009020:Morphine