title: Effectiveness of multimodal pain management after bipolar hemiarthroplasty for hip fracture: a randomized, controlled study.
abstract: BACKGROUND
  Appropriate pain management affects outcome after hip fracture surgery. Although multimodal pain management is commonly used for pain control for patients undergoing elective surgery, few studies have evaluated its use in those undergoing hip fracture surgery. This prospective randomized study was designed to determine the clinical value of multimodal pain management with preemptive pain medication and intraoperative periarticular multimodal drug injections in patients undergoing bipolar hip hemiarthroplasty.
  
  
  METHODS
  Of eighty-two cognitively intact elderly patients about to undergo bipolar hemiarthroplasty after a hip fracture, forty-three were randomly assigned to receive preemptive pain medication and intraoperative periarticular injections (Group I) and thirty-nine were assigned to not receive preemptive medication and injections (Group II). These two groups were compared with regard to the pain level on postoperative days one, four, and seven; at discharge; and when they started walking and standing exercises. Total amounts of fentanyl used, the frequency of use of patient-controlled analgesia, patient satisfaction at discharge, and perioperative complications were recorded.
  
  
  RESULTS
  Group I had a lower pain level than Group II on postoperative days one and four, but no intergroup difference in pain level was observed on postoperative day seven. The total amount of fentanyl used and the frequency of use of patient-controlled analgesia were also lower in Group I. Patient satisfaction at discharge was higher in Group I. No significant intergroup differences were found in the times until the patients walked or performed standing exercises or in the complications.
  
  
  CONCLUSIONS
  Multimodal pain management provides additional pain relief until the fourth postoperative day, improves patient satisfaction at discharge, and reduces total narcotic consumption for postoperative pain management after hip hemiarthroplasty for hip fractures.
authors.affiliation: Department of Anesthesiology and Pain Medicine, Chung-Ang University College of Medicine, 224-1 Heukseok-dong, Dongjak-gu, Seoul 156-755, South Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Kang
authors.forename: Yong-Chan
authors.initials: YC
authors.lastname: Ha
authors.forename: Jin-Yun
authors.initials: JY
authors.lastname: Kim
authors.forename: Young-Cheol
authors.initials: YC
authors.lastname: Woo
authors.forename: Jae-Sung
authors.initials: JS
authors.lastname: Lee
authors.forename: Eui-Chan
authors.initials: EC
authors.lastname: Jang
mesh_terms: D000316:Adrenergic alpha-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D000577:Amides / Q000008:administration & dosage / Q000627:therapeutic use; D016058:Analgesia, Patient-Controlled; D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000008:administration & dosage / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D015311:Cefmetazole / Q000008:administration & dosage / Q000627:therapeutic use; D000068579:Celecoxib; D016009:Chi-Square Distribution; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D004837:Epinephrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage / Q000627:therapeutic use*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007270:Injections, Intra-Articular; D020910:Ketorolac / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D009020:Morphine / Q000008:administration & dosage / Q000627:therapeutic use; D010098:Oxycodone / Q000008:administration & dosage / Q000627:therapeutic use; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000188:drug therapy*; D017060:Patient Satisfaction; D011446:Prospective Studies; D011720:Pyrazoles / Q000008:administration & dosage / Q000627:therapeutic use; D000077212:Ropivacaine; D016037:Single-Blind Method; D018709:Statistics, Nonparametric; D013449:Sulfonamides / Q000008:administration & dosage / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000316:Adrenergic alpha-Agonists; D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000900:Anti-Bacterial Agents; D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D015311:Cefmetazole; D009020:Morphine; D000077212:Ropivacaine; D010098:Oxycodone; D000068579:Celecoxib; D005283:Fentanyl; D004837:Epinephrine; D020910:Ketorolac