Joanne Lynn, MD, MA, MS
Potential Conflicts of Interest: None disclosed.
Lynn J.; Hip Fracture: A Complex Illness Among Complex Patients. Ann Intern Med. 2012;156:70-71. doi: 10.7326/0003-4819-156-1-201201030-00026
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Published: Ann Intern Med. 2012;156(1_Part_1):70-71.
TO THE EDITOR:
Hung and Morrison's editorial (1) on management of hip fracture does not address the patient in whom hip fracture will not be surgically repaired. I have had only a couple such patients who made the decision not to have surgery and were more than a few days from death. Both were competent to make their own choices, and despite encouragement to reconsider, these elderly patients stood firm and chose to die in their beds.
In caring for these patients, I could not convince anesthesiologists to consider regional approaches that might mitigate the need to use substantial narcotic analgesia and that might make it easier to maintain hygiene and to keep skin intact. PIER (http://pier.acponline.org) does mention the need to provide “adequate” doses of narcotic analgesia in persons who will not have surgical repair, thus at least noticing the problem. However, regional anesthesia could be continuous (for example, epidural) and could allow for a much more comfortable course. We should test this approach and report on the results so that patients and their physicians who choose this course have the benefit of prior experience.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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