Analgesia requirements following hip fracture in the cognitively impaired.

Abstract

The analgesia received in the 1st week of treatment by 100 consecutive acute hip fracture patients (88 female) was prospectively studied. A modified mental test was performed on all patients prior to surgery. Patients with cognitive impairment (modified mental score <5) received only 74% of the paracetamol, 43% of the non-steroidal anti-inflammatory drugs (NSAIDs), 52% of the opioid and 64% of the morphine that cognitively intact patients received. These differences were significant for paracetamol (Mann-Whitney test; p=0.001) and opioid (Mann-Whitney test; p=0. 0012) but not for NSAIDs or morphine. Either hip fracture patients with a reduced mental score perceive less pain than their more cognisant peers, or the treating clinicians perceive their pain as less, or both.