Effectiveness of multimodal pain management after bipolar hemiarthroplasty for
hip fracture: a randomized, controlled study.
Author(s): Kang H(1), Ha YC, Kim JY, Woo YC, Lee JS, Jang EC.
Affiliation(s): Author information:
(1)Department of Anesthesiology and Pain Medicine, Chung-Ang University College of
Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea.
Publication date & source: 2013, J Bone Joint Surg Am. , 95(4):291-6
BACKGROUND: Appropriate pain management affects outcome after hip fracture
surgery. Although multimodal pain management is commonly used for pain control
for patients undergoing elective surgery, few studies have evaluated its use in
those undergoing hip fracture surgery. This prospective randomized study was
designed to determine the clinical value of multimodal pain management with
preemptive pain medication and intraoperative periarticular multimodal drug
injections in patients undergoing bipolar hip hemiarthroplasty.
METHODS: Of eighty-two cognitively intact elderly patients about to undergo
bipolar hemiarthroplasty after a hip fracture, forty-three were randomly assigned
to receive preemptive pain medication and intraoperative periarticular injections
(Group I) and thirty-nine were assigned to not receive preemptive medication and
injections (Group II). These two groups were compared with regard to the pain
level on postoperative days one, four, and seven; at discharge; and when they
started walking and standing exercises. Total amounts of fentanyl used, the
frequency of use of patient-controlled analgesia, patient satisfaction at
discharge, and perioperative complications were recorded.
RESULTS: Group I had a lower pain level than Group II on postoperative days one
and four, but no intergroup difference in pain level was observed on
postoperative day seven. The total amount of fentanyl used and the frequency of
use of patient-controlled analgesia were also lower in Group I. Patient
satisfaction at discharge was higher in Group I. No significant intergroup
differences were found in the times until the patients walked or performed
standing exercises or in the complications.
CONCLUSIONS: Multimodal pain management provides additional pain relief until the
fourth postoperative day, improves patient satisfaction at discharge, and reduces
total narcotic consumption for postoperative pain management after hip
hemiarthroplasty for hip fractures.
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