Introduction: Hip fracture surgery is frequently associated with severe post-operative pain, traditionally managed using opioid-based regimens. In elderly patients, opioids are linked to adverse effects such as delirium, respiratory depression, and delayed mobilization. Opioid-sparing multimodal analgesia, incorporating non-opioid medications and regional anesthesia techniques, has emerged as a promising alternative. This study aimed to compare the efficacy and safety of an opioid-sparing multimodal analgesia regimen with standard opioid-based analgesia in patients undergoing hip fracture surgery. Materials and Methods: This prospective randomized controlled trial enrolled 50 patients aged ≥50 years undergoing operative management for hip fractures. Participants were randomized into two groups: Group M (multimodal analgesia, n = 25) and Group S (standard opioid-based analgesia, n = 25). Group M received scheduled non-opioid analgesics and a regional nerve block with opioids reserved for rescue, while Group S received conventional opioid-centered pain management. Post-operative pain was assessed using the Visual Analog Scale (VAS) at 2, 6, 12, 24, and 48 h. Total opioid consumption within 48 h, opioid-related adverse effects, incidence of delirium, time to first mobilization, length of hospital stay, and patient satisfaction were recorded. Results: Baseline characteristics were comparable between groups. Group M demonstrated significantly lower VAS scores at all time points (e.g., 24 h: 2.2 ± 0.6 vs. 3.4 ± 0.8; P < 0.001) and reduced 48-h opioid consumption (9.6 ± 3.2 mg vs. 22.8 ± 5.6 mg; P < 0.001). Opioid-related adverse effects and post-operative delirium were significantly lower in Group M (12% vs. 36%; P = 0.04). Patients in Group M achieved earlier mobilization (27.4 ± 6.8 vs. 39.6 ± 9.2 h; P < 0.001) and had shorter hospital stays (6.1 ± 1.4 vs. 8.3 ± 2.0 days; P < 0.001). Patient satisfaction was higher in the multimodal group. Conclusion: Opioid-sparing multimodal analgesia provides superior pain control with reduced opioid consumption and improved post-operative outcomes compared with standard analgesia in hip fracture surgery. Its routine adoption may enhance recovery and safety in this high-risk population.
Pandoh et al. (Thu,) studied this question.