Pain management after hip fracture repair surgery: a systematic review and procedure-specific postoperative pain management (PROSPECT) recommendations

Published online: Feb 27 2024

S. Pissens1*, L. Cavens1*, G. P. Joshi2, M.P. Bonnet3, A. Sauter4, J. Raeder5, M. Van de Velde6,
on behalf of the PROSPECT Working Group of the European Society of Regional Anaesthesia and Pain Therapy (esrA).

1 Trainee, Department of Anesthesiology, UZ Leuven, Leuven, Belgium
2 Professor, Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, Texas, USA
3 Professor in Anaesthesia, Intensive Care and perioperative medicine, Sorbonne University, Trousseau Hospital, Paris, France
4 Professor and Consultant, Oslo University Hospital Rikshospitalet, Oslo, Norway
5 Professor, Department of Anesthesiology, Oslo University Hospital and University of Oslo, Oslo, Norway
6 Professor, Department of Cardiovascular Sciences, KU Leuven and Professor and Consultant Department of Anesthesiology, UZ Leuven, Leuven, Belgium

* S. Pissens and L. Cavens equally contributed and share first authorship.


Hip fracture is associated with moderate-to-severe postoperative pain, which can influence postoperative recovery and length of stay. The aim of this systematic review was to update the available literature and develop recommendations for optimal pain management after hip fracture. A systematic review utilising procedure specific postoperative pain management (PROSPECT) methodology was undertaken. Randomised controlled trials, systematic reviews and meta-analysis published in the English language between 04 April 2005 and 12 May 2021, evaluating the effects of analgesic, anaesthetic and surgical interventions were retrieved from MEDLINE, Embase and Cochrane Databases. A total of 60 studies met the inclusion criteria. For patients having hip fracture, pre, intra and postoperative paracetamol and non-steroidal anti-inflammatory drugs or COX-2 inhibitors are recommended. A single shot femoral nerve block or a single shot fascia iliaca compartment block are recommended. Continuous catheter techniques should be used only in specific circumstances. The choice between femoral nerve block or a fascia iliaca compartment block should be made according to local expertise. The postoperative regimen should include regular paracetamol, non-steroidal anti-inflammatory drugs and COX-2 inhibitors with opioids used for rescue. Some of the interventions, although effective, carry risks, and consequentially were omitted from the recommendations, while other interventions were not recommended due to insufficient, inconsistent or lack of evidence.