Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures

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dc.contributor.advisor Shorten, George D. en
dc.contributor.advisor Iohom, Gabriella en
dc.contributor.author Szűcs, Szilárd
dc.date.accessioned 2015-11-05T11:36:08Z
dc.date.available 2015-11-05T11:36:08Z
dc.date.issued 2014
dc.date.submitted 2014
dc.identifier.citation Szűcs, S. 2014. Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures. PhD Thesis, University College Cork. en
dc.identifier.endpage 193
dc.identifier.uri http://hdl.handle.net/10468/2034
dc.description.abstract This PhD thesis describes work carried out on investigation of various interventions with the aim to optimise the anaesthetic management of patients scheduled to undergo operative fixation of hip fractures. We analysed the perioperative effects of continuous femoral nerve block, single preoperative dose of i.v. dexamethasone, the intention to deposit local anaesthetic in different locations around the femoral nerve during ultrasound guided femoral nerve block, continuous spinal anaesthesia and peri-surgical site infiltration with local anaesthetic after surgical fixation of hip fractures. Continuous femoral nerve block provided more effective preoperative analgesia six hours after the insertion of the perineural catheter compared to a standard opiate-based regimen in patients undergoing operative fixation of fractured hip. A single low dose of preoperative dexamethasone in the intervention group decreased pain scores by 75% six hours after the surgery. Both interventions had no major effect on the functional recovery in the first year after the surgical fixation of fractured hip. The results of the ultrasound guided femoral nerve block trial showed no clinical advantage of intending to deposit local anaesthetic circumferentially during performing femoral nerve block. Using the Dixon and Massey’s “up- and-down” method, we demonstrated that intrathecal 0.26 ml of 0.5% bupivacaine provided adequate surgical anaesthesia within 15 minutes in 50% of patients undergoing operative fixation of hip fracture. Finally, we demonstrated that local anaesthetic infiltration had no effect on pain scores 12 hours after the surgical fixation of fractured neck of femur. In addition to this original body of work, a review article was published on femoral nerve block highlighting the use of ultrasound guidance. In conclusion, the results of this thesis offer an insight into interventions aimed at optimising perioperative analgesia in patients scheduled to undergo operative fixation of hip fractures. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher University College Cork en
dc.rights © 2014, Szilárd Szűcs. en
dc.rights.uri http://creativecommons.org/licenses/by-nc-nd/3.0/ en
dc.subject Hip fracture en
dc.subject Continuous femoral nerve block en
dc.subject Continuous spinal anaesthesia en
dc.subject Optimal positioning of local anaesthetic en
dc.subject Dexamethasone en
dc.subject Femoral nerve block en
dc.title Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures en
dc.type Doctoral thesis en
dc.type.qualificationlevel Doctoral en
dc.type.qualificationname PhD (Medicine and Health) en
dc.internal.availability Full text available en
dc.check.info No embargo required en
dc.description.version Accepted Version
dc.description.status Not peer reviewed en
dc.internal.school Medicine en
dc.check.type No Embargo Required
dc.check.reason No embargo required en
dc.check.opt-out Not applicable en
dc.thesis.opt-out false
dc.check.embargoformat Not applicable en
ucc.workflow.supervisor g.shorten@ucc.ie
dc.internal.conferring Spring Conferring 2015

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© 2014, Szilárd Szűcs. Except where otherwise noted, this item's license is described as © 2014, Szilárd Szűcs.
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