Efficacy of Periarticular Multimodal Drug Injection Without NSAIDs in Elderly Patients With Displaced Femoral Neck Fractures Undergoing Bipolar Hemiarthroplasty: A Prospective Triple-Blinded RCT.

Abstract

IntroductionRecently, periarticular multimodal drug injection (PMDI) has demonstrated the ability to significantly reduce early postoperative pain with hip fractures in the elderly. Nonetheless, data on PMDI without non-steroidal anti-inflammatory drugs (NSAIDs) in these patients are still doubtful. The current study has evaluated the effect of PMDI with NSAIDs in elderly femoral neck fractures (FNFs) underlying bipolar hip arthroplasty (BHA).Materials and methodsA prospective triple-blinded randomized controlled trial (RCT) was conducted in 28 elderly FNFs undergoing BHA. They were randomized into two groups: PMDI group (n=14), which received intraoperative PMDI (50-mL solution of 100-mg bupivacaine, 10-mg morphine, 300-mcg epinephrine, and 750-mg cefuroxime), and a placebo group (n=14), which received only saline solution. The primary outcome was a 10-point visual analog scale (VAS). Secondary outcomes were morphine consumption and cumulative ambulatory score (CAS), postoperative complications, and functional outcomes as a timed up-and-go (TUG) test and Harris hip score (HHS) at two, six, and 12 weeks postoperatively.ResultsThe PMDI group demonstrated a significant reduction in the median VAS at the 48th hour postoperatively as compared to the placebo group (P = 0.019), and a non-significant reduction in the median VAS at the 36th and 60th hours (P = 0.058 and 0.110, respectively) and in a median dosage of morphine consumption on the second postoperative day (P = 0.140). There was no significant difference in postoperative ambulation and functional outcome between both groups (P > 0.05, all).ConclusionThe PMDI regimen without NSAIDs is effective for postoperative analgesia on the second postoperative day in elderly FNFs undergoing BHA without any significant difference in functional outcome or postoperative complications.