The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial
Yıl: 2020 Cilt: 26 Sayı: 1 Sayfa Aralığı: 109 - 114 Metin Dili: İngilizce DOI: 10.14744/tjtes.2019.78002 İndeks Tarihi: 10-11-2020
The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial
Öz: BACKGROUND: Hip fracture is a common clinical problem which causes severe pain in geriatric patients. However, severe painfollowing fracture may bring on mental disorders and delirium. A neuroinflammatory response with IL-6 and IL-8 has been shown tobe associated with the pathophysiology of delirium. In this study, our primary hypothesis is that preoperative femoral nerve block(FNB) intervention in geriatric patients will more effectively attenuate pain following trochanteric femur fracture than the preoperativeparacetamol application. Our secondary hypothesis is that interleukin levels (IL-6, IL-8) in cerebrospinal fluid (CSF) will be lower in thefemoral nerve block group than the paracetamol group. Our tertiary hypothesis is that the incidence of postoperative delirium will belower in the femoral nerve block group.METHODS: The patients over 65 years of age with ASA status II-IV and admitted to the Emergency Service for femur fracture wereincluded in this study. Recommendations of the “delirium prevention table” were applied to all of the patients at arrival. In the firstgroup, 15 mg/kg paracetamol was administered intravenously every eight hours. In the second group, femoral nerve blockage wasperformed, and a catheter was placed. Then, 0.5 mL/kg bupivacaine 0.25% was applied every eight hours. In both groups, pain scoresfour hours after interventions were recorded. All patients were operated within 48 hours under spinal anesthesia. During spinal anesthesia, 2 mL of CSF samples were taken from all patients for analysis of IL-6 and IL-8 cytokines, and pain scores during positioningwere recorded.RESULTS: VAS scores four hours after the first preoperative pain treatment and during the positioning for regional anesthesia weresignificantly lower in the femoral nerve block group. IL-8 levels are significantly lower in the femoral nerve block group but not in IL-6levels. The incidence of delirium was less in the femoral nerve block group, but the difference was not statistically significant.CONCLUSION: The femoral nerve block was more effective in preoperative pain management of trochanteric femur fracture andpreventing pain during regional anesthesia application. The mean IL-8 level was lower in the femoral nerve block group when comparedto the paracetamol group. There is no difference in the postoperative delirium incidence between groups
Anahtar Kelime: Trokanterik femur kırığı operasyonu geçirecek yaşlı hastada erken dönemde yapılan femoral sinir blokajının ağrı yönetimi ve deliryum insidansına etkisi: Randomize kontrollü çalışma
Öz: AMAÇ: Kalça kırığı yaşlı hastalarda şiddetli ağrıya neden olan yaygın bir klinik problemdir. Bununla birlikte kırık oluşumunu takip eden şiddetli ağrı mental rahatsızlıklar ve deliryum gelişimine neden olabilir. IL-6 ve IL-8 ile birlikte olan nöroinflamatuvar yanıtın deliryum patofizyolojisi ile ilişkili olduğu gösterilmiştir. Bu çalışmadaki primer hipotezimiz ameliyat öncesi femoral sinir bloğunun trokanterik femur kırıklarında parasetamole göre daha etkin ağrı tedavisi sağlayacağıdır. Sekonder hipotezimiz IL-6 ve IL-8 düzeylerinin femoral sinir bloğu yapılanlarda daha düşük olacağıdır. Üçüncü hipotezimiz ise ameliyat sonrası deliryum insidansının femoral sinir bloğu uygulananlarda düşük olma durumudur. GEREÇ VE YÖNTEM: Hastane acil servisine femur kırığı nedeniyle başvuran 65 yaş üzeri ASA II-IV hastalar çalışmaya dahil edildi. “Deliryum önleme tablosu”ndaki öneriler tüm hastalara başvuru anından itibaren uygulandı. İlk gruba sekiz saatte bir 15 mg/kg parasetamol intravenöz olarak verildi. İkinci gruba femoral sinir blokajı uygulandı ve kateter yerleştirildi. Ardından 0.5 mL/kg bupivakain %0.25 her sekiz saatte bir kateter yoluyla verildi. Her iki grupta ağrı skorları ilk analjezik uygulandıktan dört saat sonra kaydedildi. Bütün hastlar 48 saat içerisinde spinal anestezi altında ameliyat edildi. Spinal anestezi sırasında verilen pozisyona bağlı ağrı skorları kaydedildi ve 2 mL beyin omurilik sıvısı (BOS) örneği tüm hastalardan IL-6 ve IL-8 sitokinleri analizi için alındı. BULGULAR: Ameliyat öncesi ilk ağrı tedavisi sonrası dördüncü saatteki ve rejyonal anestezi için verilen pozisyon ağrısı belirgin olarak femoral sinir blok grubunda düşüktü. IL-8 düzeyleri femoral sinir blok grubunda belirgin olarak düşük iken IL-6 düzeyleri benzerdi. Deliryum insidansı femoral sinir blok grubunda daha azken istatistiksel farklılık yoktu. TARTIŞMA: Femoral sinir bloğu ameliyat öncesi ağrı tedavisinde ve rejyonal anestezi sırasındaki pozisyon ağrısını önlemede üstündür. Ortalama IL-8 düzeyi femoral sinir blokajı uygulanan hastalarda daha düşüktür. Deliryum insidansı her iki grupta benzerdir
Anahtar Kelime: Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık
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| APA | uysal a, ALTINPARMAK B, YAŞAR E, TURAN M, Canbek U, Yılmaz N, GUMUS DEMİRBİLEK S (2020). The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. , 109 - 114. 10.14744/tjtes.2019.78002 |
| Chicago | uysal ali ihsan,ALTINPARMAK Başak,YAŞAR Eylem,TURAN Mustafa Erkan,Canbek Umut,Yılmaz Nigar,GUMUS DEMİRBİLEK SEMRA The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. (2020): 109 - 114. 10.14744/tjtes.2019.78002 |
| MLA | uysal ali ihsan,ALTINPARMAK Başak,YAŞAR Eylem,TURAN Mustafa Erkan,Canbek Umut,Yılmaz Nigar,GUMUS DEMİRBİLEK SEMRA The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. , 2020, ss.109 - 114. 10.14744/tjtes.2019.78002 |
| AMA | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. . 2020; 109 - 114. 10.14744/tjtes.2019.78002 |
| Vancouver | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. . 2020; 109 - 114. 10.14744/tjtes.2019.78002 |
| IEEE | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S "The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial." , ss.109 - 114, 2020. 10.14744/tjtes.2019.78002 |
| ISNAD | uysal, ali ihsan vd. "The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial". (2020), 109-114. https://doi.org/10.14744/tjtes.2019.78002 |
| APA | uysal a, ALTINPARMAK B, YAŞAR E, TURAN M, Canbek U, Yılmaz N, GUMUS DEMİRBİLEK S (2020). The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulusal Travma ve Acil Cerrahi Dergisi, 26(1), 109 - 114. 10.14744/tjtes.2019.78002 |
| Chicago | uysal ali ihsan,ALTINPARMAK Başak,YAŞAR Eylem,TURAN Mustafa Erkan,Canbek Umut,Yılmaz Nigar,GUMUS DEMİRBİLEK SEMRA The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulusal Travma ve Acil Cerrahi Dergisi 26, no.1 (2020): 109 - 114. 10.14744/tjtes.2019.78002 |
| MLA | uysal ali ihsan,ALTINPARMAK Başak,YAŞAR Eylem,TURAN Mustafa Erkan,Canbek Umut,Yılmaz Nigar,GUMUS DEMİRBİLEK SEMRA The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulusal Travma ve Acil Cerrahi Dergisi, vol.26, no.1, 2020, ss.109 - 114. 10.14744/tjtes.2019.78002 |
| AMA | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 109 - 114. 10.14744/tjtes.2019.78002 |
| Vancouver | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial. Ulusal Travma ve Acil Cerrahi Dergisi. 2020; 26(1): 109 - 114. 10.14744/tjtes.2019.78002 |
| IEEE | uysal a,ALTINPARMAK B,YAŞAR E,TURAN M,Canbek U,Yılmaz N,GUMUS DEMİRBİLEK S "The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial." Ulusal Travma ve Acil Cerrahi Dergisi, 26, ss.109 - 114, 2020. 10.14744/tjtes.2019.78002 |
| ISNAD | uysal, ali ihsan vd. "The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial". Ulusal Travma ve Acil Cerrahi Dergisi 26/1 (2020), 109-114. https://doi.org/10.14744/tjtes.2019.78002 |
