title: Scheduled analgesic regimen improves rehabilitation after hip fracture surgery.
abstract: BACKGROUND
  Postoperative pain often is the limiting factor in the rehabilitation of patients after hip fracture surgery.
  
  
  OBJECTIVE
  We compared an approach using scheduled analgesic dosing with as-needed analgesic dosing in patients after hip fracture surgery, to compare these approaches in terms of (1) resting and dynamic pain intensity, (2) postoperative patient mobility, and (3) functional end points.
  
  
  METHODS
  We conducted a prospective cohort study of 400 patients who underwent surgical treatment of hip fractures at our hospital. The groups were formed sequentially, such that the first 200 patients formed the intervention group (treated with scheduled analgesic intake for the first 3 weeks after surgery), and the next 200 patients were the control group (treated using a protocol of analgesic administration on request). Resting and dynamic pain intensity, mobility, and functional performance were compared between the two analgesic protocols.
  
  
  RESULTS
  As expected, analgesic consumption was lower in the control group (tramadol doses, 27 versus 63; paracetamol doses, 29 versus 63). Despite the large difference in the amounts of analgesics consumed, resting and dynamic pain intensity showed improvement in each group and there was no difference between groups in terms of postoperative pain. However, there was a positive correlation between functional outcomes and analgesic consumption in the control group. The intervention group achieved higher functional performance on discharge (elderly mobility scale, 11 versus 8; functional independence measure, 88 versus 79). On discharge, fewer patients in the intervention group were wheelchair ambulators (3 versus 32), meaning more patients in the intervention group were able to walk.
  
  
  CONCLUSIONS
  The study showed that a scheduled analgesic intake can improve the functional outcomes of patients with geriatric hip fractures after surgery.
  
  
  METHODS
  Level II, therapeutic study. See the guidelines for authors for a complete description of levels of evidence.
authors.affiliation: Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital, Kowloon, Hong Kong, China.
authors.forename: Raymond Ping-Hong
authors.initials: RP
authors.lastname: Chin
authors.forename: Chin-Hung
authors.initials: CH
authors.lastname: Ho
authors.forename: Lydia Po-Chee
authors.initials: LP
authors.lastname: Cheung
mesh_terms: D000082:Acetaminophen / Q000008:administration & dosage*; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage*; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D001696:Biomechanical Phenomena; D016009:Chi-Square Distribution; D051341:Dependent Ambulation; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D005593:Fracture Fixation, Internal / Q000009:adverse effects; D006620:Hip Fractures / Q000503:physiopathology / Q000601:surgery*; D006621:Hip Joint / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D051346:Mobility Limitation; D010147:Pain Measurement; D010149:Postoperative Pain / Q000175:diagnosis / Q000188:drug therapy* / Q000209:etiology; D010351:Patient Discharge; D011446:Prospective Studies; D020127:Recovery of Function; D013997:Time Factors; D014147:Tramadol / Q000008:administration & dosage*; D016896:Treatment Outcome; D016138:Walking
chemical_list: D018712:Analgesics, Non-Narcotic; D000701:Analgesics, Opioid; D000082:Acetaminophen; D014147:Tramadol
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