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

Area of Science:

• Orthopedic Surgery
• Pain Management
• Geriatric Medicine

Background:

• Elderly hip fractures lead to high morbidity and mortality.
• Delayed surgery often causes inadequate pain control and increased opioid use.
• Effective preoperative pain management for femoral neck fractures (FNFs) is crucial.

Purpose of the Study:

• To evaluate the effectiveness of preoperative intra-articular injection of multimodal analgesics (IA MDI) for pain reduction in displaced FNFs.
• To assess IA MDI's impact on opioid consumption and perioperative outcomes.
• To determine if IA MDI is a viable adjunct for preoperative pain management.

Main Methods:

• Prospective randomized controlled trial with 18 geriatric patients with displaced FNFs.
• Two groups: IA MDI (ropivacaine, morphine, adrenaline injection) and control (standard analgesics).
• Primary outcome: Numerical Rating Scale (NRS) pain scores; Secondary outcomes: morphine consumption, complications, hospital stay, functional outcome.

Main Results:

• IA MDI group showed significantly reduced NRS pain scores in the preoperative 24-hour period (p < 0.05).
• Median morphine consumption was significantly lower in the IA MDI group (0 mg vs. 6 mg, p = 0.033).
• No significant differences in postoperative pain, complications, hospital stay, or functional outcomes between groups.

Conclusions:

• Preoperative IA MDI effectively reduced preoperative pain intensity and opioid consumption in elderly FNF patients.
• IA MDI is a feasible and potentially useful adjunct for preoperative pain management in FNFs.
• This pilot study suggests IA MDI can be safely incorporated into FNF care pathways.