A recently published study in the journal 'Geriatric Orthopaedic Surgery & Rehabilitation' highlighted the need for adequately constructed pathway-driven comparator studies of contemporary analgesia regimes, with preoperative intravenous paracetamol (IVP) as a critical feature to optimise pain control and minimise analgesia-related morbidity in this vulnerable population.  

The interventions focusing on improving patient comfort and reducing complication burden have increased importance with an increasing number of patients sustaining hip fractures. Frailty, cognitive impairment, and difficulty in assessing pain control distinguish this population. Therefore, Ján Dixon et al. reviewed pain assessment and the use of preoperative IVP.

The authors considered the systematic review of preoperative IVP administration in patients presenting with a hip fracture. In the hip fracture population, Intravenous paracetamol is useful in the early management of pain control. There is a significant decrease in the use of breakthrough pain medications than with other pain relieving modalities. Also, IVP decreases the incidence of opioid-induced complications, lessen the length of stay, and lowers mean pain scores. The poor administration of all analgesics to patients with hip fracture with up to 72% sustaining no prehospital analgesia was a notable finding of this study.

Hence, the potential advantages of IVP as routine in the early management of hip fracture-related pain are well understood. But as there are not many studies based on the direct comparison between analgesia regimes to inform optimum bundles of analgesic care, further investigations are needed.