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Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study

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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).

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Authors and Affiliations

  1. 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

    Alessandro Di Filippo, Peggy Ruggiano & Silvia Falsini

  2. Department of Orthopedics, Anesthesia Unit, Careggi Hospital, Largo Brambilla 3, 50124, Florence, Italy

    Manuela Magherini

  3. Department of Orthopedics, Unit of General Orthopedics and Traumatology, Careggi Hospital, Largo Brambilla 3, 50124, Florence, Italy

    Antonio Ciardullo

Authors
  1. Alessandro Di Filippo
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  2. Manuela Magherini
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  3. Peggy Ruggiano
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  4. Antonio Ciardullo
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  5. Silvia Falsini
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Correspondence to Alessandro Di Filippo.

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Di Filippo, A., Magherini, M., Ruggiano, P. et al. Postoperative analgesia in patients older than 75 years undergoing intervention for per-trochanteric hip fracture: a single centre retrospective cohort study. Aging Clin Exp Res 27, 281–285 (2015). https://doi.org/10.1007/s40520-014-0272-5

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  • DOI: https://doi.org/10.1007/s40520-014-0272-5

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