Intravenous paracetamol (and its prototype- propacetamol) has been established to be a safe and effective analgesic for preoperative pain management for patients with hip fracture. However, the current literature is based on small scale studies and there is a need for large randomized controlled trials to determine the efficacy of routine intravenous paracetamol in patients with hip fracture.

As the number of patients sustaining hip fractures is ever increasing, the interventions focused on improving patient comfort and reducing the complication burden is of utmost importance. Frailty, cognitive impairment, and difficulty in estimating pain control characterize this population. For future care, a review of pain assessment and the use of preoperative intravenous paracetamol (IVP) is demonstrated.

A systematic review of preoperative IVP administration in patients with a hip fracture.

Intravenous paracetamol is useful in the early management of pain control in the hip fracture population. There is a considerable decrease in the use of breakthrough pain medications when compared with other pain relief modalities. Additionally, IVP reduces the incidence of opioid-induced complications, reduces the length of stay, and lowers mean pain scores. Another notable finding of this study is the poor administration of all analgesics to patients with hip fracture with up to 72% obtaining no prehospital analgesia.

The possible advantages of IVP as routine in the early management of hip fracture-related pain are evident. The studies depicting the direct comparison between analgesia regimes to inform optimum bundles of analgesic care are limited. This study supports the need for adequately constructed pathway-driven comparator studies of contemporary analgesia regimes. These studies should have IVP as a central feature to optimize pain control and decrease the analgesia-related morbidity in this vulnerable population.