Best Evidence Summary for Perioperative Pain Management in elderly Hip Fracture Patients

To synthesize the current evidence on perioperative pain management in older adults with hip fractures and to provide an evidence-based reference to support clinical decision-making by healthcare professionals.

This review was conducted in accordance with the evidence synthesis methodology developed by the Joanna Briggs Institute (JBI). Guided by the "6S" evidence hierarchy model, a top-down search strategy was employed to identify evidence related to pain management in older adults with hip fractures. The evidence sources included clinical decision support tools, recommended practices, clinical guidelines, best practice statements, evidence summaries, systematic reviews, and expert consensus statements. The search covered literature from database inception to November 30, 2023. Two reviewers independently screened and appraised the literature, followed by data extraction and synthesis based on the JBI Levels of Evidence and Grades of Recommendation.

A total of 14 papers were included in the analysis, including one clinical decision, one recommended practice, seven guidelines, two expert consensus, one evidence summary, and two systematic reviews. Based on the synthesis and integration of the extracted evidence, five thematic domains were identified: pain assessment, nonpharmacological interventions, pharmacologic interventions, Traditional Chinese Medicine, and health education. A total of 25 best evidence statements were ultimately formulated.

This study summarizes the best evidence for perioperative pain management in elderly patients with hip fractures. The evidence covers key aspects such as optimal timing of pain assessment, appropriate tool selection, and consideration of individualized factors during evaluation. It also addresses nonpharmacological and pharmacological interventions across the preoperative, intraoperative, and postoperative phases. These findings provide a scientific and practical foundation for healthcare professionals to implement systematic and evidence-based pain management strategies in this patient population.