Loading

International Journal of Clinical Anesthesiology

The Effect of Post-Operative Infiltration of Local Anaesthetic Agents into Post –Fracture Neck of Femur Wounds on Patient Stay and Mobilization

Case Report | Open Access

  • 1. Tameside General Hospital of Manchester, UK, The National Hospital of Sri Lanka
+ Show More - Show Less
Corresponding Authors
Thisara C. Weerasuriya, Tameside General Hospital Of Manchester, UK, The National Hospital of Sri Lanka
Abstract

Fracture neck of femur is a common orthopaedic condition which is increasing in incidence in the whole world with the aging of the populations. In this study done in Sri Lanka and the UK over a period of three years a total of 256 fracture neck of femur patients were observed for post-operative duration of stay, pain scoring and date of first mobilization. This study was done prospectively from January 2010 to January 2013. A retrospective analysis of 256 patients who had operations for fracture neck of femur from 2007 to 2010 who did not receive local anaesthetic infiltration into the surgical wound were done to compare the results between the two groups.

The mean stay in hospital for the group of patients who had local anaesthetics injected was 05 days where as for the group of patients who did not have such injections was 06 days. At a p value of 0.05 there was no statistical significance noted between the two groups. The post-operative pain score of 0-10 on the first postoperative day, the group who had local infiltration had a mean score of 04 where as the group that did not have infiltration had a mean score of 06. Once again this was not statistically significant at a p value of 0.05. At the 04th post-operative day both groups had a mean pain score of 04.

The group that received local infiltration of the wound were able to mobilize from bed to chair on a mean of 1.5 days post-operatively while the group that did not receive local infiltration mobilized from bed to chair on a mean of 2 days which was not statistically significant.

There was no statistically significant difference between injecting local anaesthesia to the operative incision site in patients who have had surgical operations for fracture neck of femur. The pain due to the incision itself played a minor role in the total pain profile and there was o statistical significance of eliminating the wound pain in these patients.

Citation

Weerasuriya TC, Chan F, Pinto N (2013) The Effect of Post-Operative Infiltration of Local Anaesthetic Agents into Post –Fracture Neck of Femur Wounds on Patient Stay and Mobilization. Int J Clin Anesthesiol 1(2): 1010.

INTRODUCTION

Fracture neck of femur is a common orthopaedic condition in the elderly populations of developing as well as the developed world. With the world population aging fast this is a huge burden on the health care systems all over the globe. In this study we wanted to find out whether the infiltration of local anaesthetic agents into the operative wound of patients who had their hip fractures surgically operated on will have an effect on the pain score of the post operative period: overall hospital stay and on the ability to mobilize early.

We did this in as a prospective study involving a tertiary care centre in Sri Lanka where 256 patients received local anaesthetic infiltration to the operative wound for pain relief as a local protocol. We also combined a retrospective analysis of a similar number of patients who had their hips operated on for fracture neck of femurs in the UK where such practice is not part of the protocol of treating fracture neck of femurs.

METHODS

This study was conducted with the objective of identifying whether infiltration of local anaesthetic into the operative wound in patients who had surgical operations for fracture neck of femur would affect post operative duration of hospital stay, pain score and early mobilization.

The study was done as a prospective study for the group who routinely received local anaesthetic injections as per local protocol on a developing country and as a retrospective study where patients don’t routinely receive such infiltration, in a developed country. Patients who had fractures of the neck of the femur of 65 years and above were included in the prospective as well as in the retrospective groups. Both intra-capsular as well as extra-capsular fractures were included. Pathological fractures due to bone tumours were excluded from the study. A total of 256 patients were questioned and observations were recorded by trained observers using direct observation and a pre-validated questionnaire to obtain information on post-operative pain scores in the prospective group. A retrospective analysis of 256 patients who had hip operations for fracture neck of femur were retrospectively analysed using clinical records and the same information was extracted. Patients with incomplete clinical records were not included in the study, from the retrospective group.

The retrospective group was closely matched with the prospective group to reduce errors due to confounding variables. The authors were mindful about the prospective group being of Asian origin and the retrospective group being of Caucasian origin.

RESULTS

In the retrospective group the average age was 78 years and in the prospective group the average age was 76 years. In both groups 79% were females with fracture neck of femurs. In both groups nearly 68% were intra-capsular fractures.

The average duration of hospital stay of the two groups were 05 days for the prospective group and the retrospective group showed a mean of 06 days which was not statistically significant at a p value of 0.05.

The post-operative pain score of 0-10 on the first post operative day, the group who had local infiltration had a mean score of 04 where as the group that did not have infiltration had a mean score of 06. Once again this was not statistically significant at a p value of 0.05. At the 04th post-operative day both groups had a mean pain score of 04.

The group that received local infiltration of the wound were able to mobilize from bed to chair on a mean of 1.5 days postoperatively while the group that did not receive local infiltration mobilized from bed to chair on a mean of 2 days which was not statistically significant.

We also looked at wound complications of both groups and found that 07 patients had wound dehiscence in the prospective group and 09 patients had wound dehiscence in the retrospective group which was once again statistically not significant. Infection of wounds confirmed by bacterial swab culture was nearly same in percentage of both groups.

Table 1: Gender Distribution.

Males 22% Prospective group 21% Retrospective group
Females 78% Prospective group 79% Retrospective group

Table 2: Age Distribution.

Group Males/yrs Females/yrs
Prospective 81 76
Retrospective 80 77

 

DISCUSSION

Fracture neck of femur is a common orthopaedic condition in the elderly populations of developing as well as the developed world. With the world population aging fast this is a huge burden on the health care systems all over the globe. In this study we wanted to find out whether the infiltration of local anaesthetic agents into the operative wound of patients who had their hip fractures surgically operated on will have an effect on the pain score of the post operative period: overall hospital stay and on the ability to mobilize early.

We did this in as a prospective study involving a tertiary care centre in Sri Lanka where 256 patients received local anaesthetic infiltration to the operative wound for pain relief as a local protocol. We also combined a retrospective analysis of a similar number of patients who had their hips operated on for fracture neck of femurs in the UK where such practice is not part of the protocol of treating fracture neck of femurs.

Our study was unique due to the fact that it was carried out on patient who had operations following hip fractures. Many publications have been found in the literature about local anaesthetic infiltration following total hip and knee arthroplasty.

A study done in Denmark showed that 40 patients who underwent total hip replacement were randomized into two groups in this double-blinded study. They received wound infiltration at the end of surgery. The other group received a placebo. A significant reduction in the hospital stay and a marked early mobililization rate was noted [1].

Operative and postoperative wound infiltration reduces pain and the requirement for analgesics after hip replacement1 . Our study however failed to show a statistically significant difference in reducing the pain as well as in the early mobilization and reduction of the hospital stay in patients with hip fractures who had operative procedures done on them.

A second randomised study of 40 patients where intraarticular analgesia with multimodal drugs demonstrated that infiltration provided superior pain relief and reduced morphine consumption compared with continuous epidural after TKA [2]. A pub med search failed to demonstrate any articles giving information on local wound infiltration following operations for fracture neck of femurs.

Received : 09 Sep 2013
Accepted : 28 Sep 2013
Published : 30 Sep 2013
Journals
Annals of Otolaryngology and Rhinology
ISSN : 2379-948X
Launched : 2014
JSM Schizophrenia
Launched : 2016
Journal of Nausea
Launched : 2020
JSM Internal Medicine
Launched : 2016
JSM Hepatitis
Launched : 2016
JSM Oro Facial Surgeries
ISSN : 2578-3211
Launched : 2016
Journal of Human Nutrition and Food Science
ISSN : 2333-6706
Launched : 2013
JSM Regenerative Medicine and Bioengineering
ISSN : 2379-0490
Launched : 2013
JSM Spine
ISSN : 2578-3181
Launched : 2016
Archives of Palliative Care
ISSN : 2573-1165
Launched : 2016
JSM Nutritional Disorders
ISSN : 2578-3203
Launched : 2017
Annals of Neurodegenerative Disorders
ISSN : 2476-2032
Launched : 2016
Journal of Fever
ISSN : 2641-7782
Launched : 2017
JSM Bone Marrow Research
ISSN : 2578-3351
Launched : 2016
JSM Mathematics and Statistics
ISSN : 2578-3173
Launched : 2014
Journal of Autoimmunity and Research
ISSN : 2573-1173
Launched : 2014
JSM Arthritis
ISSN : 2475-9155
Launched : 2016
JSM Head and Neck Cancer-Cases and Reviews
ISSN : 2573-1610
Launched : 2016
JSM General Surgery Cases and Images
ISSN : 2573-1564
Launched : 2016
JSM Anatomy and Physiology
ISSN : 2573-1262
Launched : 2016
JSM Dental Surgery
ISSN : 2573-1548
Launched : 2016
Annals of Emergency Surgery
ISSN : 2573-1017
Launched : 2016
Annals of Mens Health and Wellness
ISSN : 2641-7707
Launched : 2017
Journal of Preventive Medicine and Health Care
ISSN : 2576-0084
Launched : 2018
Journal of Chronic Diseases and Management
ISSN : 2573-1300
Launched : 2016
Annals of Vaccines and Immunization
ISSN : 2378-9379
Launched : 2014
JSM Heart Surgery Cases and Images
ISSN : 2578-3157
Launched : 2016
Annals of Reproductive Medicine and Treatment
ISSN : 2573-1092
Launched : 2016
JSM Brain Science
ISSN : 2573-1289
Launched : 2016
JSM Biomarkers
ISSN : 2578-3815
Launched : 2014
JSM Biology
ISSN : 2475-9392
Launched : 2016
Archives of Stem Cell and Research
ISSN : 2578-3580
Launched : 2014
Annals of Clinical and Medical Microbiology
ISSN : 2578-3629
Launched : 2014
JSM Pediatric Surgery
ISSN : 2578-3149
Launched : 2017
Journal of Memory Disorder and Rehabilitation
ISSN : 2578-319X
Launched : 2016
JSM Tropical Medicine and Research
ISSN : 2578-3165
Launched : 2016
JSM Head and Face Medicine
ISSN : 2578-3793
Launched : 2016
JSM Cardiothoracic Surgery
ISSN : 2573-1297
Launched : 2016
JSM Bone and Joint Diseases
ISSN : 2578-3351
Launched : 2017
JSM Bioavailability and Bioequivalence
ISSN : 2641-7812
Launched : 2017
JSM Atherosclerosis
ISSN : 2573-1270
Launched : 2016
Journal of Genitourinary Disorders
ISSN : 2641-7790
Launched : 2017
Journal of Fractures and Sprains
ISSN : 2578-3831
Launched : 2016
Journal of Autism and Epilepsy
ISSN : 2641-7774
Launched : 2016
Annals of Marine Biology and Research
ISSN : 2573-105X
Launched : 2014
JSM Health Education & Primary Health Care
ISSN : 2578-3777
Launched : 2016
JSM Communication Disorders
ISSN : 2578-3807
Launched : 2016
Annals of Musculoskeletal Disorders
ISSN : 2578-3599
Launched : 2016
Annals of Virology and Research
ISSN : 2573-1122
Launched : 2014
JSM Renal Medicine
ISSN : 2573-1637
Launched : 2016
Journal of Muscle Health
ISSN : 2578-3823
Launched : 2016
JSM Genetics and Genomics
ISSN : 2334-1823
Launched : 2013
JSM Anxiety and Depression
ISSN : 2475-9139
Launched : 2016
Clinical Journal of Heart Diseases
ISSN : 2641-7766
Launched : 2016
Annals of Medicinal Chemistry and Research
ISSN : 2378-9336
Launched : 2014
JSM Pain and Management
ISSN : 2578-3378
Launched : 2016
JSM Women's Health
ISSN : 2578-3696
Launched : 2016
Clinical Research in HIV or AIDS
ISSN : 2374-0094
Launched : 2013
Journal of Endocrinology, Diabetes and Obesity
ISSN : 2333-6692
Launched : 2013
Journal of Substance Abuse and Alcoholism
ISSN : 2373-9363
Launched : 2013
JSM Neurosurgery and Spine
ISSN : 2373-9479
Launched : 2013
Journal of Liver and Clinical Research
ISSN : 2379-0830
Launched : 2014
Journal of Drug Design and Research
ISSN : 2379-089X
Launched : 2014
JSM Clinical Oncology and Research
ISSN : 2373-938X
Launched : 2013
JSM Bioinformatics, Genomics and Proteomics
ISSN : 2576-1102
Launched : 2014
JSM Chemistry
ISSN : 2334-1831
Launched : 2013
Journal of Trauma and Care
ISSN : 2573-1246
Launched : 2014
JSM Surgical Oncology and Research
ISSN : 2578-3688
Launched : 2016
Annals of Food Processing and Preservation
ISSN : 2573-1033
Launched : 2016
Journal of Radiology and Radiation Therapy
ISSN : 2333-7095
Launched : 2013
JSM Physical Medicine and Rehabilitation
ISSN : 2578-3572
Launched : 2016
Annals of Clinical Pathology
ISSN : 2373-9282
Launched : 2013
Annals of Cardiovascular Diseases
ISSN : 2641-7731
Launched : 2016
Journal of Behavior
ISSN : 2576-0076
Launched : 2016
Annals of Clinical and Experimental Metabolism
ISSN : 2572-2492
Launched : 2016
Clinical Research in Infectious Diseases
ISSN : 2379-0636
Launched : 2013
JSM Microbiology
ISSN : 2333-6455
Launched : 2013
Journal of Urology and Research
ISSN : 2379-951X
Launched : 2014
Journal of Family Medicine and Community Health
ISSN : 2379-0547
Launched : 2013
Annals of Pregnancy and Care
ISSN : 2578-336X
Launched : 2017
JSM Cell and Developmental Biology
ISSN : 2379-061X
Launched : 2013
Annals of Aquaculture and Research
ISSN : 2379-0881
Launched : 2014
Clinical Research in Pulmonology
ISSN : 2333-6625
Launched : 2013
Journal of Immunology and Clinical Research
ISSN : 2333-6714
Launched : 2013
Annals of Forensic Research and Analysis
ISSN : 2378-9476
Launched : 2014
JSM Biochemistry and Molecular Biology
ISSN : 2333-7109
Launched : 2013
Annals of Breast Cancer Research
ISSN : 2641-7685
Launched : 2016
Annals of Gerontology and Geriatric Research
ISSN : 2378-9409
Launched : 2014
Journal of Sleep Medicine and Disorders
ISSN : 2379-0822
Launched : 2014
JSM Burns and Trauma
ISSN : 2475-9406
Launched : 2016
Chemical Engineering and Process Techniques
ISSN : 2333-6633
Launched : 2013
Annals of Clinical Cytology and Pathology
ISSN : 2475-9430
Launched : 2014
JSM Allergy and Asthma
ISSN : 2573-1254
Launched : 2016
Journal of Neurological Disorders and Stroke
ISSN : 2334-2307
Launched : 2013
Annals of Sports Medicine and Research
ISSN : 2379-0571
Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
Author Information X