Geriatric Pain Protocol: Impact of Multimodal Pain Care for Elderly Orthopaedic Trauma Patients.
Paulina Andujo, Kelsey Yue, Karma McKelvey and 2 others
PMID 37494900WHAT IT FOUND
A multimodal pain protocol lowered opioid doses on days 1 and 2 after hip fracture surgery without worsening pain.
It did not reduce length of stay, complications, or delirium. The protocol combined nerve blocks, acetaminophen, celecoxib, and limited opioids.
Key findings
01Opioid usage in morphine milligram equivalents was lower in the protocol group than in the non-protocol group on postoperative day 1 (p = .007) and postoperative day 2 (p = .043).
02There were no between-group differences in the occurrence of postoperative delirium, inpatient complications, or 30-day readmissions (all ps > .1).
03The protocol included a preoperative fascia iliaca nerve block, acetaminophen, celecoxib, and as-needed tramadol, oxycodone, or hydromorphone.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This was a non-randomized quality improvement initiative, so baseline differences between groups (such as age and provider type) may have influenced results. The study was not powered to detect small differences in outcomes. Intraoperative anesthetic techniques and medications were not tracked, which could affect postoperative pain and delirium. Data were collected from a single inpatient unit at one academic medical center, limiting generalizability.
Declared interests
The paper states it was an operational quality improvement project exempt from institutional review board approval. No specific funding sources or author conflicts of interest are declared in the text provided.
The easy way to misread this
Do not conclude that the protocol improves functional outcomes or reduces delirium. The study found no significant difference in length of stay, complications, readmissions, or delirium rates between the protocol and usual care groups.