Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT

Abstract

Introduction Recently, periarticular multimodal drug injection (PMDI) has demonstrated the ability to significantly reduce early postoperative pain with hip fractures in the elderly. Nonetheless, data on PMDI without non-steroidal anti-inflammatory drugs (NSAIDs) in these patients are still doubtful. The current study has evaluated the effect of PMDI with NSAIDs in elderly femoral neck fractures (FNFs) underlying bipolar hip arthroplasty (BHA). Materials and methods A prospective triple-blinded randomized controlled trial (RCT) was conducted in 28 elderly FNFs undergoing BHA. They were randomized into two groups: PMDI group (n=14), which received intraoperative PMDI (50-mL solution of 100-mg bupivacaine, 10-mg morphine, 300mcg epinephrine, and 750-mg cefuroxime), and a placebo group (n=14), which received only saline solution. The primary outcome was a 10-point visual analog scale (VAS). Secondary outcomes were morphine consumption and cumulative ambulatory score (CAS), postoperative complications, and functional outcomes as a timed up-and-go (TUG) test and Harris hip score (HHS) at two, six, and 12 weeks postoperatively.

Intraoperatively local infiltration anesthesia in hemiarthroplasty patients reduces the needs of opioids: a randomized, double-blind, placebo-controlled trial with 96 patients in a fast-track hip fracture setting

“…Our findings of reduced opioid consumption are in accordance with 2 other randomized trials on hemiarthroplasty patients ( 11 , 12 ). These studies also found reduced pain for the LIA group.…”

“…The other study used LIA without NSAIDs ( 12 ). Their findings of reduced pain sensation, however, were after 36 and 60 hours postoperatively, which is quite late when reckoning that the LIA effect would last up to 24 hours ( 17 ).…”

“…Studies investigating LIA in hip fracture patients in general report a low pain score in the early postoperative phase, demonstrating that the patients are well pain relieved ( 11 , 12 ). In our study, the multimodal analgesic regimen included both preoperative dexamethasone and a femoral hip blockade.…”

“…There are surprisingly few studies investigating the postoperative pain management following hemiarthroplasty in hip fracture patients ( 11 , 12 ). The pain management is often based on knowledge regarding pain treatment of elective total hip arthroplasty patients, although both the nature of the injury and the patient population are quite different.…”