January 11, 2012
Volume 7 - Issue 2     

DynaMed Weekly Update

For the week ending January 6, 2012  

Last week 598 articles were evaluated via DynaMed's Systematic Literature Surveillance and 285 were added to DynaMed content. 

Based on the editors' criteria of selecting "articles most likely to change clinical practice," one article of significant interest was selected for the DynaMed Weekly Update.

Feature Article

Hydromorphone for Postoperative Pain Does Not Appear to Increase Delirium in Elderly Patients having Hip Fracture Surgery


Postoperative delirium is common in elderly patients following surgery for hip fracture repair. Some doctors may be reluctant to fully treat the postoperative pain due to concerns that opioid treatment could increase delirium risk. In particular, meperidine (Demerol) has been found to be associated with increased risk of delirium in elderly postoperative patients in a systematic review (Anesth Analg. 2006 Apr;102(4):1255). A recent study investigated the effects of the opioid hydromorphone on cognitive impairment in a cohort of 236 consecutive patients (mean age 82 years) having hip fracture surgery. Patients were assessed at baseline for preexisting dementia and were followed for postoperative pain, hydromorphone use and incidence of delirium. Patients with preoperative delirium were excluded.


At baseline, 28% of patients had dementia determined by preoperative exam or history. Hydromorphone was given intravenously postoperatively to maintain a pain score ≤ 3 on a 0-10 oral rating scale. The drug was given to 93% of patients without dementia and to 83% of patients with dementia. There was no significant association between hydromorphone use and delirium in either patients without dementia (p = 0.33) or patients with dementia (p = 0.4) (level 2 [mid-level] evidence). Mean pain scores and opioid use were significantly lower in patients with dementia compared to those without dementia. The strongest predictor of postoperative delirium was preexisting dementia: delirium occurred in 51.5% of patients with dementia and 15.3% of patients without dementia (odds ratio 5.86, p < 0.001). Intensive care unit admission was also strongly associated with delirium (odd ratio 2.71, p = 0.006) (J Am Geriatr Soc 2011 Dec;59(12):2256).


For more information, see the Hip fracture topic in DynaMed.

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Call for Peer Reviewers

We are currently seeking reviewers for:


Andersen-Tawil syndrome

Tibial plateau fracture

Transient synovitis of the hip


Learn more about the DynaMed Contribution Opportunities:

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About DynaMed Weekly Update

Prepared by the clinician members of the DynaMed Editorial Team, DynaMed Weekly Update is a compilation of one to five articles selected from DynaMed's Systematic Literature Surveillance as articles most likely to change clinical practice.

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CME Information


0.25 AMA PRA Category I Credit(s)™
Family Physicians: 0.25 Prescribed credits
Nurse Practitioners: 0.25 Contact hours
Release Date: January 11, 2012 
Expiration Date: January 11, 2013
Estimated Completion Time:
15 minutes
There is no fee for this activity.

To Receive Credit 
In order to receive your certificate of participation, you should read the information about this activity, including the disclosure statements, review the entire activity, take the post-test, and complete the evaluation form. You may then follow the directions to print your certificate of participation. To begin, click the CME icon at the end of the article.

Program Overview

Learning Objectives

Upon successful completion of this educational program, the reader should be able to:
1. Discuss the significance of this article as it relates to your clinical practice.
2. Be able to apply this knowledge to your patient's diagnosis, treatment and management.
Faculty Information
Alan Ehrlich, MD - Assistant Clinical Professor in Family Medicine, University of Massachusetts Medical School, Worcester, Massachusetts, USA; Deputy Editor, DynaMed, Ipswich, Massachusetts, USA

Michael Fleming, MD, FAAFP - Assistant Clinical Professor of Family Medicine and Comprehensive Care, LSU Health Science Center School of Medicine, Shreveport, Louisiana, USA; Assistant Clinical Professor of Family Medicine, Department of Family and Community Medicine, Tulane University Medical School, New Orleans, Louisiana, USA; Chief Medical Officer, Amedisys, Inc. & Antidote Education Company

Dr. Ehrlich, Dr. Fleming, DynaMed Editorial Team members, and the staff of Antidote Education Company have disclosed that they have no relevant financial relationships or conflicts of interest with commercial interests related directly or indirectly to this educational activity.
No commercial support has been received for this activity.

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AAFP: This activity, DynaMed Weekly Update 2011, has been reviewed and is acceptable for up to 13 Prescribed credits by the American Academy of Family Physicians. AAFP accreditation begins March 2, 2011. Term of approval is for one year from this date. Each Weekly Update is approved for 0.25 Prescribed credits. Credit may be claimed for one year from the date of each Weekly Update.


AANP: This program is approved for 0.25 contact hour of continuing education by the American Academy of Nurse Practitioners.  

Program ID 1102071T.

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