Pain control in acute hip fracture
| Dose | Comments | |
|---|---|---|
| First line: nonopioid analgesia | ||
| Peripheral nerve block (femoral nerve block, fascia iliaca block) | Ropivacaine 0.5%, 15–20 mL in primary block; if catheter placed, infusion may be run with ropivacaine 0.2% at 8–10 mL/hour | Quadriceps weakness can be a limitation |
| Acetaminophen | 1,000 mg intravenously or orally every 6 hours | For patient weighing < 50 kg, orally 650 mg every 6 hours |
| Celecoxib | 200 mg orally twice a day | Use if glomerular filtration rate is > 60 mL/min |
| Ibuprofen | 400 mg by mouth every 6 hours | Use if glomerular filtration rate is > 60 mL/min |
| Opioids | ||
| Tramadol | 50 mg orally every 6 hours as needed for mild to moderate pain | Use 25 mg if creatinine clearance rate is < 60 mL/min |
| Oxycodone | 2.5–5 mg orally every 4–6 hours as needed for severe pain | Start with 2.5 mg if creatinine clearance rate is < 60 mL/min |
| Hydromorphone | 0.25 mg intravenously every 4–6 hours as needed | Preferable to morphine, since morphine’s metabolites can accumulate in patients with impaired renal function Respiratory depression, delirium, urinary retention, sedation, nausea and vomiting, and constipation are side effects of all opioids. Elderly patients may be particularly vulnerable to changes in mental status with opioids |