ArticleJournal of orthopaedic case reports2026
Opioid-Sparing Multimodal Analgesia versus Standard Analgesia in Hip Fracture Surgery: A Prospective Study.
Article in Journal of orthopaedic case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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