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British Journal of Anaesthesia 2009 102(1):111-116; doi:10.1093/bja/aen345
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2009. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Postoperative pain after hip fracture is procedure specific

N. B. Foss1,2,*, M. T. Kristensen2,3, H. Palm2 and H. Kehlet4

1 Department of Anesthesiology
2 Department of Orthopedic Surgery
3 Department of Physiotherapy
4 Section of Surgical Pathophysiology 4074, Rigshospitalet Copenhagen University, Copenhagen DK-2100, Denmark

* Corresponding author: Department of Anesthesiology, Rigshospitalet, Copenhagen DK-2100, Denmark. E-mail: nbf{at}comxnet.dk/nicoli.bang.foss{at}hh.hosp.dk

Background: Hip fracture patients experience high pain levels during postoperative rehabilitation. The role of surgical technique on postoperative pain has not been evaluated previously.

Methods: One hundred and seventeen hip fracture patients were included in a descriptive prospective study. All patients received continuous epidural analgesia and were treated according to a standardized perioperative rehabilitation programme. Resting pain, pain on hip flexion, and walking were measured during daily physiotherapy sessions on a verbal five-point rating scale during the first four postoperative days. Patients were stratified into four groups according to surgical procedure: screws or pins, arthroplasty, dynamic hip screw (DHS), and intra-medullary hip screw (IMHS).

Results: Cumulated pain levels were significantly different between surgical procedures both for hip flexion (P=0.002) and for walking (P=0.02) with highest dynamic pain levels for patients who had either DHSs or IMHSs compared with arthroplasty or parallel implants. There were significant negative correlations between ambulatory capacity assessed by the cumulated ambulation score and both the dynamic cumulated pain scores on hip flexion (r=–0.43, P<0.001) and walking (r=–0.36, P=0.004).

Conclusions: Postoperative pain levels after surgery for hip fracture are dependent on the surgical procedure, which should be taken into account in future studies of analgesia and rehabilitation.

Keywords: complications, fracture; pain, postoperative


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