Effects of Intraoperative Local Pain Cocktail Injections on Early Function and Patient-Reported Outcomes: A Randomized Controlled Trial

J Orthop Trauma. 2023 Sep 1;37(9):433-439. doi: 10.1097/BOT.0000000000002628.

Abstract

Objective: To determine whether a perioperative pain cocktail injection improves postoperative pain, ambulation distance, and long-term outcomes in patients with hip fracture.

Design: Prospective, single-blinded, randomized controlled trial.

Setting: Academic Medical Center.

Patients/participants: Patients with OTA/AO 31A1-3 and 31B1-3 fractures undergoing operative fixation, excluding arthroplasty.

Intervention: Multimodal local injection of bupivacaine (Marcaine), morphine sulfate (Duramorph), ketorolac (Toradol) given at the fracture site at the time of hip fracture surgery (Hip Fracture Injection, HiFI).

Main outcome measurements: Patient-reported pain, American Pain Society Patient Outcome Questionnaire (APS-POQ), narcotic usage, length of stay, postoperative ambulation, Short Musculoskeletal Function Assessment.

Results: Seventy-five patients were in the treatment group and 109 in the control group. Patients in the HiFI group had a significant reduction in pain and narcotic usage compared with the control group on postoperative day (POD) 0 ( P < 0.01). Based on the APS-POQ, patients in the control group had a significantly harder time falling asleep, staying asleep, and experienced increased drowsiness on POD 1 ( P < 0.01). Patient ambulation distance was greater on POD 2 ( P < 0.01) and POD 3 ( P < 0.05) in the HiFI group. The control group experienced more major complications ( P < 0.05). At 6-week postop, patients in the treatment group reported significantly less pain, better ambulatory function, less insomnia, less depression, and better satisfaction than the control group as measured by the APS-POQ. The Short Musculoskeletal Function Assessment bothersome index was also significantly lower for patients in the HiFI group, P < 0.05.

Conclusions: Intraoperative HiFI not only improved early pain management and increased ambulation in patients undergoing hip fracture surgery while in the hospital, it was also associated with early improved health-related quality of life after discharge.

Level of evidence: Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Trial registration: ClinicalTrials.gov NCT03693404.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Anesthetics, Local*
  • Bupivacaine
  • Hip Fractures* / complications
  • Humans
  • Morphine / therapeutic use
  • Narcotics / therapeutic use
  • Pain, Postoperative / diagnosis
  • Pain, Postoperative / drug therapy
  • Pain, Postoperative / prevention & control
  • Patient Reported Outcome Measures
  • Prospective Studies
  • Quality of Life

Substances

  • Anesthetics, Local
  • Bupivacaine
  • Morphine
  • Narcotics

Associated data

  • ClinicalTrials.gov/NCT03693404