Analgesia requirements following hip fracture in the cognitively impaired.

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.