Läkartidningen
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Randomized Controlled Trial Comparative Study Clinical Trial
[Femoral nerve block as pain relief in hip fracture. A good alternative in perioperative treatment proved by a prospective study].
Almost 25% of all patients with hip fracture experience temporary confusion pre- and directly postoperatively due to trauma, advanced age, transport between units, and the use of analgesics, 35-50% of the patients suffer temporary or chronic decubitus. Analgesics often lead to nausea. A femoral nerve block can interrupt sensory impulses from the hip joint and provide complete pain relief without affecting the CNS, thus making preoperative care easier and postoperative rehabilitation can be started earlier. 80 consecutive patients with hip fracture were randomized to femoral nerve block or pharmacological treatment only. ⋯ Femoral nerve block provides adequate pain relief, equivalent to pharmacological treatment in most patients. The time for postoperative mobilization was shorter and less temporary confusion was seen. There were no complications in this group, making nerve block a good alternative to traditional pharmacological preoperative treatment for patients with hip fractures.
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Emotional reactions are important sequelae of stroke. Mood disorders, such as depression, anxiety, post-traumatic stress syndrome and emotionalism, occur during the first post-stroke year, each of them in approximately 20-30% of patients. They often overlap, and prevalence estimates differ on account of differences in definitions; study populations; exclusion criteria and time of assessment. ⋯ Some patients recover spontaneously but symptoms persist in up to one third. Pharmacological treatment can have a positive effect that also applies to rehabilitation, quality of life and cardiovascular mortality. However, study findings are not uniform and conclusive therapeutic and preventive intervention trials on mood disorders after stroke are urgently needed.