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Background: There is a need for appropriate pain control in the geriatric hip fracture population to prevent diminished function, increased mortality, and opioid dependence. Multimodal pain therapy is one method for reducing pain postoperatively while also decreasing opioid use in the geriatric hip fracture patient. This study aimed to determine whether multimodal pain therapy could decrease opioid use without increasing pain scores in surgical geriatric hip fracture patients., Methods: This was a before-and-after cohort study. The hospital implemented multimodal pain control order sets with a standardized pain regimen and performed retrospective chart review pre- and postorder set implementation for analysis., Results: A total of 248 patients were enrolled in the study: 131 in the preorder set group and 117 in the postorder set group. The mean postoperative oral morphine equivalent (OME) was significantly lower in the postorder set group than in the preorder set group (45.1 mg vs. 63.4 mg, respectively, p = .03). Compared with the preorder set group, total OME and postoperative OME were decreased by 22.6% (95% confidence interval [CI] -44.9, -3.8), 1-tailed p < .01, and 53.6% (95% CI -103.4, -16.1), 1-tailed p <.01 respectively, in the postorder set group. There was not a statistically significant difference in mean pain scores at 6, 24, and 48 hr postoperatively (p = .53, .10, and .99), respectively., Conclusion: Implementing a multimodal approach to pain management may help reduce opioid use and may be a critical maneuver in averting the national opioid epidemic.

Introduction: This study examines the use of remifentanil, an ultra-short-acting opioid, in emergency department (ED) patients., Methods: Chart review of ED patients receiving remifentanil for procedural sedation in an urban general ED., Results: 50 patients over a 28-month period with a mean age of 30.6 years (±2.6) were reviewed. Procedures performed included: abscess drainage (13); fracture care (9); thoracostomy (8); lumbar puncture (7); shoulder reduction (3); cardioversion (3) and others (7). Six (12%) cases received additional rescue medications. All procedures were successfully completed in the ED. No complications were recorded but 21 (42%) were admitted for underlying pathology., Conclusion: Remifentanil is a safe and effective medication for ED use.