Perioperative Analgesic Strategies for Long Bone Fractures. Is There a Need for a Standardized Protocol? A Scoping Review

Abstract

Acute perioperative pain that accompanies limb fractures and exceeds the threshold of tolerability has a high risk of becoming chronic. There are many controversies regarding current pain management options, like opioids and nonsteroidal anti-inflammatory drugs. This study aimed to comprehensively search the literature for ways to achieve perioperative analgesia in patients with long bone fractures. This research was a scoping review that included a systematic search of randomized controlled trials and observational studies in three international databases: MEDLINE, Scopus, and Web of Science. Ten thousand nine hundred forty-three articles were found and screened. After applying the inclusion and exclusion criteria, 77 articles were included in the final descriptive analysis. Peripheral nerve blocks play a significant role in perioperative multimodal analgesia; of the articles described in this review, 46.75% revolved around regional anesthesia. Other findings of pharmacologic agents that are of benefit in improving pain scores in surgically treated long bone fractures and need future research are Gabapentinoids, Magnesium sulphate, Vitamin C, Esmolol, and low-dose Ketamine.