Multimodal Analgesia in the Hip Fracture Patient.

摘要: Hip fracture is one of the most common injuries among elderly and, because population aging, it expected to remain a major clinical challenge and public health problem for foreseeable future. The importance early mobilization prompt participation in physical therapy after hip surgery now widely recognized. Because postoperative pain can impair mobility delay therapy, much attention being paid finding more effective ways controlling fracture. Oversedation with opioid drugs inhibits communication between patient care team, ambulation rehabilitation may increase probability requiring skilled nursing facility, which adds further cost overall system. Multiple pathways contribute perception pain, although opioids are highly blocking nociceptive through inhibition mu receptors, they do not block other pathways. Multimodal analgesia involves use several anesthetic analgesic modalities that strategically combined at different sites peripheral central nervous systems. This balanced, multifaceted approach provides control than alone, allows lower doses be used as part multimodal regimen (thereby reducing risk opioid-related adverse events complications), facilitate rapid recovery improve certain outcome measures related time. One prospective randomized study evaluating value management patients undergoing bipolar hemiarthroplasty found regimen, including preemptive medication intraoperative periarticular injections, reduced on days 1 4, use. article describes an patients.