For patients who have experienced a hip fracture, pain is one of the main physiological and psychological stresses. A patient’s pre–hip fracture pain medications should be reviewed (as applicable) to assess the need for continuation or substitution while in hospital.
Opioids are effective at relieving acute pain; however, they are associated with side effects including confusion, vomiting, constipation, sedation, and respiratory depression. It is important to consider the use of multimodal analgesia to reduce dose-dependent opioid-related side effects. Nonnarcotic systemic analgesics, such as acetaminophen and nonsteroidal anti-inflammatory drugs (if not contraindicated), and peripheral nerve blocks, such as a fascia iliaca or femoral nerve block, can improve pain control, reduce postoperative delirium, and reduce overall opioid requirements. Peripheral nerve blockade should be performed by medical practitioners with appropriate training, with consideration of the benefits and risks of the procedure, and with an explanation of the procedure to the patient.
Choice of Anaesthesia
Patients undergoing hip fracture surgery receive either neuraxial or general anaesthesia. As current evidence suggests that the two modalities are equivalent for most outcomes, the choice of anaesthesia should be made based on patient characteristics and, where possible, in consultation with the patient and family or caregivers. Neuraxial anaesthesia may be contraindicated for patients on anticoagulation medication; surgery should not be delayed if general anaesthesia is an acceptable option.