Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures

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dc.check.embargoformatNot applicableen
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dc.contributor.advisorShorten, George D.en
dc.contributor.advisorIohom, Gabriellaen
dc.contributor.authorSzűcs, Szilárd
dc.date.accessioned2015-11-05T11:36:08Z
dc.date.available2015-11-05T11:36:08Z
dc.date.issued2014
dc.date.submitted2014
dc.description.abstractThis 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.description.statusNot peer revieweden
dc.description.versionAccepted Version
dc.format.mimetypeapplication/pdfen
dc.identifier.citationSzűcs, S. 2014. Optimizing perioperative analgesia for patients undergoing operative fixation of hip fractures. PhD Thesis, University College Cork.en
dc.identifier.endpage193
dc.identifier.urihttps://hdl.handle.net/10468/2034
dc.language.isoenen
dc.publisherUniversity College Corken
dc.rights© 2014, Szilárd Szűcs.en
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/3.0/en
dc.subjectHip fractureen
dc.subjectContinuous femoral nerve blocken
dc.subjectContinuous spinal anaesthesiaen
dc.subjectOptimal positioning of local anaestheticen
dc.subjectDexamethasoneen
dc.subjectFemoral nerve blocken
dc.thesis.opt-outfalse
dc.titleOptimizing perioperative analgesia for patients undergoing operative fixation of hip fracturesen
dc.typeDoctoral thesisen
dc.type.qualificationlevelDoctoralen
dc.type.qualificationnamePhD (Medicine and Health)en
ucc.workflow.supervisorg.shorten@ucc.ie
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