{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T11:03:15Z","timestamp":1772103795475,"version":"3.50.1"},"reference-count":21,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Faculty of Medicine Ramathibodi Hospital, Mahidol University","award":["RF_67004"],"award-info":[{"award-number":["RF_67004"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Hip fractures among elderly patients are associated with significant morbidity and mortality. Delayed surgery is common and often results in inadequate pain control and increased opioid consumption, which may have adverse effects. This study evaluates the effectiveness of preoperative intra-articular injection of multimodal analgesics (IA MDI) for reducing pain caused by a displaced femoral neck fracture (FNF). Methods: A prospective randomized controlled trial was conducted using 18 geriatric patients with displaced FNFs scheduled for hip arthroplasty. The patients were randomized into two groups: IA MDI and control groups (n = 9 each). The IA MDI group was administered a preoperative intra-articular injection of ropivacaine, morphine, and adrenaline, in addition to standard oral and intravenous (IV) analgesics, while the control group was administered standard oral and IV analgesics alone. The primary outcome was the perioperative pain score assessed via the 10-point numerical rating scale (NRS). The secondary outcomes were morphine consumption, perioperative complications, length of hospital stay, and functional outcome. Results: During the first 24 h preoperative period after admission, the IA MDI group exhibited a significant reduction in the average NRS at all timepoints (p &lt; 0.05 all) and in the median dosage of morphine consumption (0 mg vs. 6 mg, p = 0.033) compared to the control group. There was no significant difference between groups in terms of postoperative pain and complications, length of hospital stays, or functional outcomes (p &gt; 0.05 all). Conclusions: Preoperative IA MDI significantly reduced pain intensity and opioid consumption during the preoperative 24 h window among elderly patients with FNFs without provoking a corresponding increase in observed complications in this pilot randomized controlled study. IA MDI is a feasible option and could be a useful adjunct for preoperative pain management for FNFs.<\/jats:p>","DOI":"10.3390\/jcm15051762","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T09:31:32Z","timestamp":1772098292000},"page":"1762","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Preoperative Pain Control for a Femoral Neck Fracture Using Intra-Articular Multimodal Drug Injection"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-2605-360X","authenticated-orcid":false,"given":"Konlawat","family":"Sabsuantang","sequence":"first","affiliation":[{"name":"Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siraphat","family":"Ponghunsa","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jinnipa","family":"Arunothai","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vachirasorn","family":"Anannor","sequence":"additional","affiliation":[{"name":"Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Atikun","family":"Natee","sequence":"additional","affiliation":[{"name":"Chakri Naruebodindra Medical Institute, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Samut Prakan 10540, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1936-4456","authenticated-orcid":false,"given":"Paphon","family":"Sa-Ngasoongsong","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2151459320922473","DOI":"10.1177\/2151459320922473","article-title":"One-year mortality rates following fracture of the femoral neck treated with hip arthroplasty in an aging Saudi population: A trauma center experience","volume":"11","author":"Alshaalan","year":"2020","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1859","DOI":"10.1111\/j.1526-4637.2010.00983.x","article-title":"Causes and consequences of inadequate management of acute pain","volume":"11","author":"Sinatra","year":"2010","journal-title":"Pain. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"876","DOI":"10.1302\/2633-1462.68.BJO-2025-0083.R1","article-title":"Avoidable and unavoidable delays in hip fracture surgery: A prospective observational study of who, what, and why?","volume":"6","author":"Sarkies","year":"2025","journal-title":"Bone Jt. Open"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"3218","DOI":"10.1007\/s11999-010-1756-z","article-title":"Effects of delayed hip fracture surgery on mortality and morbidity in elderly patients","volume":"469","author":"Carpintero","year":"2011","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1007\/s11914-020-00578-3","article-title":"Management of pain associated with fractures","volume":"18","author":"Elsevier","year":"2020","journal-title":"Curr. Osteoporos. Rep."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/aas.13491","article-title":"Pre-operative femoral nerve block for hip fracture-A systematic review with meta-analysis","volume":"64","author":"Skjold","year":"2020","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1016\/j.bjae.2024.02.005","article-title":"Innervation of the hip joint: Implications for regional anaesthesia and image-guided interventional pain procedures","volume":"24","author":"Pun","year":"2024","journal-title":"BJA Educ."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"S6","DOI":"10.1097\/BOT.0000000000000561","article-title":"Multimodal Analgesia in the Hip Fracture Patient","volume":"30","author":"Fabi","year":"2016","journal-title":"J. Orthop. Trauma."},{"key":"ref_9","first-page":"e10271","article-title":"Efficacy of periarticular multimodal drug injection without NSAIDs in elderly patients with displaced femoral neck fractures undergoing bipolar hemiarthroplasty: A prospective triple-blinded randomized controlled trial","volume":"12","author":"Orapin","year":"2020","journal-title":"Cureus"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e24596","DOI":"10.1097\/MD.0000000000024596","article-title":"Intraoperative periarticular injection can alleviate the inflammatory response and enhance joint function recovery after hip arthroplasty in elderly patients with osteoporotic femoral neck fractures","volume":"100","author":"Xiong","year":"2021","journal-title":"Medicine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2006","DOI":"10.1016\/j.arth.2021.01.017","article-title":"Effectiveness of Periarticular Injection After Bipolar Hemiarthroplasty for Displaced Femoral Neck Fracture in Elderly Patients: A Double Blinded Randomized, Controlled Study","volume":"36","author":"Phruetthiphat","year":"2021","journal-title":"J. Arthroplasty"},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Olsen, M.F., Bjerre, E., Hansen, M.D., Hilden, J., Landler, N.E., Tendal, B., and Hr\u00f3bjartsson, A. (2017). Pain relief that matters to patients: Systematic review of empirical studies assessing the minimum clinically important difference in acute pain. BMC Med., 15.","DOI":"10.1186\/s12916-016-0775-3"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"572","DOI":"10.1016\/j.arthro.2016.09.037","article-title":"An Anatomic Analysis of Mid-anterior and Anterolateral Approaches for Hip Arthrocentesis: A Male Cadaveric Study","volume":"33","author":"Mikula","year":"2017","journal-title":"Arthroscopy"},{"key":"ref_14","first-page":"300","article-title":"Fluoroscopically Guided Lateral Approach Hip Injection","volume":"36","author":"Wixson","year":"2019","journal-title":"Fed. Pract."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2203","DOI":"10.1016\/j.injury.2018.09.042","article-title":"Fascia-iliaca compartment block vs intra-articular hip injection for preoperative pain management in intracapsular hip fractures: A blind, randomized, controlled trial","volume":"49","author":"Aprato","year":"2018","journal-title":"Injury"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Zhang, H., Li, N., Li, J., and Zhang, L. (2022). Chronic Pain after Bone Fracture: Current Insights into Molecular Mechanisms and Therapeutic Strategies. Brain Sci., 12.","DOI":"10.3390\/brainsci12081056"},{"key":"ref_17","first-page":"100282","article-title":"FactFinders for patient safety: Preventing local anesthetic-related complications: Local anesthetic chondrotoxicity and stellate ganglion blocks","volume":"2","author":"Saffarian","year":"2023","journal-title":"Interv. Pain. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1080\/000164700317411889","article-title":"Intraarticular morphine after arthroscopic ACL reconstruction: A double-blind placebo-controlled study of 40 patients","volume":"71","author":"Brandsson","year":"2000","journal-title":"Acta Orthop. Scand."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"3345","DOI":"10.1177\/0363546517724423","article-title":"In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications","volume":"45","author":"Abrams","year":"2017","journal-title":"Am. J. Sports Med."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1056\/NEJM199506223322506","article-title":"The control of pain in peripheral tissue by opioids","volume":"332","author":"Stein","year":"1995","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1136\/bjsports-2014-094570","article-title":"Ultrasound-guided hip joint injections are more accurate than landmark-guided injections: A systematic review and meta-analysis","volume":"50","author":"Hoeber","year":"2016","journal-title":"Br. J. Sports Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1762\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T10:04:52Z","timestamp":1772100292000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/5\/1762"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":21,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15051762"],"URL":"https:\/\/doi.org\/10.3390\/jcm15051762","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}