Effectiveness of multimodal analgesia on surgically treated geriatric hip fracture patients: a propensity score matching analysis

Background To investigate whether multimodal analgesia can decrease pain scores while reducing opioid usage. Methods This retrospective comparative study was performed in a single institution. Data were collected from medical records between January 2008 and December 2023 for patients who underwent surgical treatment for hip fracture (femoral neck, intertrochanteric, and subtrochanteric fractures). A standardized multimodal analgesia protocol for hip fracture, encompassing a systematic approach for analgesic prescription, anesthesia type, and regional nerve block, was implemented starting in 2022. We excluded the years 2019–2021 as a transition period. Patients treated between 2008 and 2018 formed the group without multimodal analgesia (the control group, n=1088), and those treated between 2022 and 2023 formed the multimodal analgesia group (n=306). Using propensity score matching, we matched patients in the multimodal analgesia group 1:1 to those in the control group. Primary outcomes were pain scores (visual analog scale: 6 hours, 12 hours, 24 hours, and 48 hours postoperatively) and oral opioid use within 48 hours postoperatively, both compared between the two groups. Rehabilitation rates, postoperative complications, and mortality were also compared. Results Following propensity score matching, each group included 280 patients. The mean age was 75.5±11.9 years (range, 20–99 years) and 76.9±11.7 years (range, 35–99 years) in the control group and multimodal analgesia group, respectively. Male patients accounted for 31% and 30%, respectively. Postoperatively, the multimodal analgesia group showed lower pain scores (6 hour: 1.9 vs 2.9, p<0.001; 24 hours: 2.0 vs 2.4, p=0.001; 48 hours: 1.7 vs 2.2, p<0.001) and 48-hour opioid usage (5.5 vs 13.3 mg, p=0.014). Conclusions Our findings showed that implementing a multimodal analgesia protocol for hip fracture surgery was associated with lower postoperative pain and reduced opioid consumption, supporting the adoption of multimodal analgesia as a standardized perioperative pain management approach in geriatric patients with hip fractures.