RESUMO
INTRODUCTION: Patients with hip fractures (HF) may have severe pain on arrival to the emergency department (ED) and have traditionally been treated with systemic opioids. The aim of this study was to investigate the effect of fascia iliaca compartment block (FICB) performed by ED physician trainees in patients with HF. MATERIAL AND METHODS: This prospective study included 102 patients with femoral neck fractures. After arrival to the ED they received a FICB. The block was performed by ED physician trainees who injected a weight-adjusted amount of 5 mg/ml ropivacaine. Pain intensity at rest was registered immediately before the block (T0) and after one hour (T1) using a visual analogue scale (VAS). Adequate pain relief was defined as VAS = 3 at rest, at T1. RESULTS: Pain intensity at rest was VAS 7 (IQR 5-8) and 3 (IQR 2-6) at T0 and T1, respectively (p < 0.001). At T1 32% of the patients had adequate pain relief (VAS = 3) at rest. Patients with adequate pain relief at T1 had a shorter length of hospital stay compared with other patients: 10.5 (IQR 4-17) versus 13.4 (IQR 7.5-25.7) days, (p < 0.001). There were no differences in incidence of postoperative complications, hospital mortality or 180 day mortality between the groups. There were no local or systemic side effects to the blockades. CONCLUSION: FICB performed by the ED trainees is a suitable method for acute pain relief in patients with HF, but only results in adequate pain relief at rest in 1/3 of the patients.
Assuntos
Anestésicos Locais/administração & dosagem , Fraturas do Colo Femoral/terapia , Fraturas do Quadril/terapia , Bloqueio Nervoso/métodos , Manejo da Dor , Idoso , Idoso de 80 Anos ou mais , Serviço Hospitalar de Emergência , Fáscia/inervação , Fraturas do Colo Femoral/complicações , Fraturas do Colo Femoral/cirurgia , Fraturas do Quadril/complicações , Fraturas do Quadril/cirurgia , Humanos , Ílio/inervação , Dor/etiologia , Medição da Dor , Estudos ProspectivosRESUMO
STUDY DESIGN: We randomized 200 patients after lumbar discectomy to receive epidural steroid or none with a 2-year follow-up. OBJECTIVE: To evaluate the outcome, neurologic impairment and safety of epidural steroid following lumbar discectomy for herniated disc disease. SUMMARY OF BACKGROUND DATA: Convalescence after discectomy for herniated disc disease is dependent on pain and the inflammatory response. Previous studies in arthroscopic and abdominal surgery demonstrate steroids, which reduce the inflammatory response and enhance recovery. Here we report a 2-year follow-up of a randomized trial of epidural steroid following lumbar discectomy. METHODS: Through 2001 and 2003 200 patients undergoing discectomy for herniated disc disease were randomly allocated to receive epidural methylprednisolone 40 mg or none. In the control group (62 males and 38 females, median age 41 years, 18-66) 48 L5, 50 L4, and 6 L3 discectomies were performed and in the intervention group (60 males and 40 females, median age 45 years, 15-53) 56 L5, 46 L4, and 3 L3 discectomies. Contemporary with randomization to epidural steroid or none both groups received preoperative prophylactic antibiotics and the same multimodal pain treatment. RESULTS: Hospital stay was reduced from 8 to 6 days (P = 0.0001) and the number of patients with neurologic signs were reduced more (70% vs. 44%, P = 0.0004) by epidural steroid. Incidence of reoperation at 1 year was 6% in both groups and 8% in the control group and 7% in the intervention group after 2 years. No infections were registered. CONCLUSION: Epidural methylprednisolone enhances recovery after discectomy for herniated disc disease without apparent side effects.