Effectiveness of multimodal analgesia on surgically treated geriatric hip fracture patients: a propensity score matching analysis.

Abstract

Background: To investigate whether multimodal analgesia can decrease pain scores while reducing opioid usage.

Methods: This retrospective comparative study was performed in a single institution. Data were collected from medical records between January 2008 and December 2023 for patients who underwent surgical treatment for hip fracture (femoral neck, intertrochanteric, and subtrochanteric fractures). A standardized multimodal analgesia protocol for hip fracture, encompassing a systematic approach for analgesic prescription, anesthesia type, and regional nerve block, was implemented starting in 2022. We excluded the years 2019-2021 as a transition period. Patients treated between 2008 and 2018 formed the group without multimodal analgesia (the control group, n=1088), and those treated between 2022 and 2023 formed the multimodal analgesia group (n=306). Using propensity score matching, we matched patients in the multimodal analgesia group 1:1 to those in the control group. Primary outcomes were pain scores (visual analog scale: 6 hours, 12 hours, 24 hours, and 48 hours postoperatively) and oral opioid use within 48 hours postoperatively, both compared between the two groups. Rehabilitation rates, postoperative complications, and mortality were also compared.

Results: Following propensity score matching, each group included 280 patients. The mean age was 75.5±11.9 years (range, 20-99 years) and 76.9±11.7 years (range, 35-99 years) in the control group and multimodal analgesia group, respectively. Male patients accounted for 31% and 30%, respectively. Postoperatively, the multimodal analgesia group showed lower pain scores (6 hour: 1.9 vs 2.9, p<0.001; 24 hours: 2.0 vs 2.4, p=0.001; 48 hours: 1.7 vs 2.2, p<0.001) and 48-hour opioid usage (5.5 vs 13.3 mg, p=0.014).

Conclusions: Our findings showed that implementing a multimodal analgesia protocol for hip fracture surgery was associated with lower postoperative pain and reduced opioid consumption, supporting the adoption of multimodal analgesia as a standardized perioperative pain management approach in geriatric patients with hip fractures.