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17-01-2013 | Geriatrics | Article

Multimodal strategy reduces postop hip pain

Abstract

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medwireNews: Multimodal pain management significantly reduces elderly patient discomfort in the days following hip fracture surgery, demonstrates research published in TheJournal of Bone and Joint Surgery.

Pre-emptive pain medication 1 hour before surgery combined with intraoperative periarticular injections significantly reduced pain on days 1 and 4 after bipolar hemiarthroplasty compared with standard postoperative patient-controlled pain relief in the patients, aged 65 to 92 years old, report Yong-Chan Ha and co-workers from Chung-Ang University College of Medicine in Seoul, South Korea.

The 43 patients randomly assigned to receive multimodal pain relief had lower visual analog scale (VAS) maximum scores for pain on day 1 than the 39 patients given no pre-emptive or periarticular pain relief (4.8 vs 5.8). This was also true for day 4 (3.8 vs 4.8) but by day 7 after surgery, and at discharge, the treatment groups did not significantly differ.

Patients who received multimodal pain management pushed the patient-controlled analgesia button 59% less often than controls (13.5 vs 33.0 times), and required 29% less fentanyl in the first 60 hours after surgery compared with patients given only postoperative patient-controlled analgesia (666 vs 935 µg).

Furthermore, the use of patient-controlled analgesia showed a fair correlation with the VAS maximum and minimum scores, the researchers note.

Although patient satisfaction was significantly higher in patients given multimodal pain management than controls, there was no significant difference in time to walking or duration of hospital stay.

In an accompanying editorial, Charles Cornell (Hospital for Special Surgery, New York, USA) writes that the study's results are weakened by the lack of placebo and the open-label design, and the premature end to trial recruitment.

"Much larger study cohorts will be needed to discern if real clinical benefits can be realized in terms of avoidance of complications and faster recovery," he comments.

Nevertheless, Cornell says he is "a believer:""There is still much to be learned about postoperative pain management, and I am encouraged by these modest successes."

By Lynda Williams, Senior medwireNews Reporter

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