RecommendationEnsure analgesia is sufficient to allow movements necessary for investigations (as indicated by the ability to tolerate passive external rotation of the leg), and for nursing care and rehabilitation.
Relative values of different outcomesThis group of patients is most commonly elderly and frail and pain is one of the main physiological and psychological stresses they face. Therefore, the GDG considered pain relief (for example as indicated by the need for ‘breakthrough analgesia’) to be the most important outcome. The GDG also considered adverse events outcomes to be important.
Trade off between clinical benefits and harmsProviding adequate levels of analgesia is essential in improving the patients' wellbeing and minimising their discomfort whilst clinical investigations are being carried out. Gentle rotation of the leg may be associated with some degree of pain but would not otherwise cause any additional harm to the patient. There are no other identifiable harms from carrying out this assessment.
Economic considerationsThe beneficial outcomes of ensuring that adequate analgesia is provided to allow patients' movements are likely to offset the staff time required).
Quality of evidenceThere have been no studies of this approach to achieving adequate analgesia. The recommendation is based on GDG consensus.
Other considerationsIn both the pre and postoperative periods if the patient can tolerate passive rotation of the leg then this gives an indication they will be comfortable for preoperative radiographs as well as initial postoperative mobilisation. This procedure should adequately predict the adequacy of analgesia when patients subsequently have to be moved (e.g. on and off examination surfaces) for investigational procedures, such as X-rays.

From: 7, Analgesia

Cover of The Management of Hip Fracture in Adults
The Management of Hip Fracture in Adults [Internet].
NICE Clinical Guidelines, No. 124.
National Clinical Guideline Centre (UK).
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