Preoperative Pain Control for a Femoral Neck Fracture Using Intra-Articular Multimodal Drug Injection

TL;DR

This study shows that injecting a mix of pain medications into the hip joint before surgery can reduce pain and opioid use in elderly patients with hip fractures.

Contribution

The study introduces preoperative intra-articular multimodal drug injection as a novel method for pain management in femoral neck fracture patients.

Findings

Intra-articular injection reduced pain scores significantly in the first 24 hours preoperatively.

The injection group consumed less morphine compared to the control group.

No significant differences were found in postoperative outcomes or complications between groups.

Abstract

Background/Objectives: Hip fractures among elderly patients are associated with significant morbidity and mortality. Delayed surgery is common and often results in inadequate pain control and increased opioid consumption, which may have adverse effects. This study evaluates the effectiveness of preoperative intra-articular injection of multimodal analgesics (IA MDI) for reducing pain caused by a displaced femoral neck fracture (FNF). Methods: A prospective randomized controlled trial was conducted using 18 geriatric patients with displaced FNFs scheduled for hip arthroplasty. The patients were randomized into two groups: IA MDI and control groups (n = 9 each). The IA MDI group was administered a preoperative intra-articular injection of ropivacaine, morphine, and adrenaline, in addition to standard oral and intravenous (IV) analgesics, while the control group was administered standard oral and IV analgesics alone. The primary outcome was the perioperative pain score assessed via the 10-point numerical rating scale (NRS). The secondary outcomes were morphine consumption, perioperative complications, length of hospital stay, and functional outcome. Results: During the first 24 h preoperative period after admission, the IA MDI group exhibited a significant reduction in the average NRS at all timepoints (p < 0.05 all) and in the median dosage of morphine consumption (0 mg vs. 6 mg, p = 0.033) compared to the control group. There was no significant difference between groups in terms of postoperative pain and complications, length of hospital stays, or functional outcomes (p > 0.05 all). Conclusions: Preoperative IA MDI significantly reduced pain intensity and opioid consumption during the preoperative 24 h window among elderly patients with FNFs without provoking a corresponding increase in observed complications in this pilot randomized controlled study. IA MDI is a feasible option and could be a useful adjunct for preoperative pain management for FNFs.

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