Strong evidence supports multimodal pain management after hip fracture surgery.

Rationale
Five high strength (Mouzopoulos et al 14, Matot et al  16, Lamb et al  142, Kang et al  143, Gorodetskyi et al 144) and five moderate strength (Bech et al 145, Foss et al 146, Ogilvie-Harris et al 147, Spansberg et al 148, Tuncer et al 149) studies support this recommendation. Neurostimulation, local anesthetics, regional anesthetics, epidural anesthetics, relaxation, combination techniques, and pain protocols have been shown to reduce pain as well as improve satisfaction, improve function, reduce complications, reduce nausea and vomiting, reduce delirium, decrease cardiovascular events, and reduce opiate utilization. There are a large variety of techniques that result in modest but significant positive improvements in many clinical and patient-centered domains with minimal significant adverse outcomes noted. While no particular technique is recommended, using an array of pain management modalities is appropriate.
 
Risks and Harms of Implementing this Recommendation
Potential risks include medication risks and those associated with the particular procedures or techniques.
 
Future Research
Further study is necessary to define which modalities offer the most benefit at the lowest cost and risk. Further study is necessary to determine which combinations offer the most synergy. Additional study is necessary to determine if any particular modality improves functional and system outcomes as well as pain and satisfaction.
 
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