Analgesics in postoperative care in hip fracture patients with dementia – reported by nurses

Authors

  • Maija Rantala MNSc,

    PhD Student, Corresponding author
    1. Department of Nursing Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
    • Correspondence: Maija Rantala, PhD Student, Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland. Telephone: +358 40 8401515.

      E-mail: momaatta@student.uef.fi

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  • Sirpa Hartikainen MD,

    Professor of Geriatric Pharmacotherapy
    1. Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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  • Tarja Kvist PhD,

    University Researcher
    1. Department of Nursing Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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  • Päivi Kankkunen PhD

    Docent, University Lecturer
    1. Department of Nursing Sciences, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
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  • I state on behalf of all authors that the work has not been published and is not being considered for publication elsewhere.

Abstract

Aims and objectives

To describe the analgesic use in hip fracture patients with dementia during the first two postoperative days as reported by nurses.

Background

Nurses play a pivotal role in treating postoperative pain in patients with dementia and monitoring the effects of administered analgesics.

Design

Cross-sectional descriptive questionnaire study in seven university hospitals and 10 central hospitals in Finland.

Methods

The study was conducted from March until May in 2011 in Finland. For this analysis, the focus was on the sample of nurses (n = 269) who were working in orthopaedic units. Analgesics were classified according to the Anatomical Therapeutic Chemical Classification System. Nonparametric tests were applied to find out the significant differences between analgesic use and different hospitals.

Results

Paracetamol and strong opioids administered orally or parenterally seemed to be the most typical of postoperatively used types of analgesics in patients with dementia. Nonsteroidal anti-inflammatory analgesics and weak opioids were also commonly reported to be in use. There were no statistically significant differences between hospitals in typical daily doses. The majority of the nurses reported that the primary aim of postoperative pain management in hip fracture patients with dementia was ‘slight pain, which does not prevent normal functioning' (72%).

Conclusion

The pharmacological postoperative pain treatment in acute care was commonly based on the use of strong opioids and paracetamol in hip fracture patients with dementia. The reported use of transdermal opioids and codeine combination warrants further examination. Further studies are also needed to find out whether the pain is appropriately and adequately treated.

Relevance to clinical practice

Transdermal opioids and codeine combination may not be relevant analgesics for acute pain management in older adults. It is important to create a balance between sufficient pain relief and adverse effects of analgesics to allow early mobilisation and functional recovery.

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