**15. Postoperative analgesia methods in hip fracture surgery**

Pain management in hip fracture operations is multimodal. The combined use of different effect mechanistic analgesics provides less pain relief resulting in less opioid use and less complications [15].

Inadequate postoperative pain treatment causes prolonged hospitalization and additional malignancy. Inadequate pain management leads to the chronicity of the pain and the decrease in the quality of life of the patient.

Intraoperative analgesic treatment from the preoperative epidural catheter ensures that the patient does not have pain at the end of the operation. The patient can return to daily activities more quickly. Patient-controlled analgesia (PCA) technique is frequently used in postoperative pain management. It can be administered via peripheral intravenous or epidural catheter. Peripheral nerve blocks can also be provided with PCA using catheter.

Bupivacaine and opioid protocols. are mostly used in regionalized PCA. It should be noted that opioids administered by the epidural route may also cause sedation.

**Periarticular injection** and multimodality in patients with hip arthroplasty should be part of the treatment [16]. Periarticular injection solution includes; bupivacaine 0.5% 200–400 mg, morphine sulfate 4–10 mg, epinephrine 300 mcg, methylprednisolone 40 mg, cefuroxime 750 mg and 0.9% NaCl. The total volume is 60 ml.

Periarticular injection is applied in anterior capsule, iliopsoas tendon and inseriosion before reduction. After reduction,it is applied in abductor, fascia lata, snovia, gluteus maximus and insercius, posterior capsules, short external rotators.

**Duration of hospital stay and ambulance**: The average length of hospital stay is 3 days in hip arthroplasty. After a hip fracture repair, the average time for elderly patients is 20 days. Although there are many studies advocating that neuro-axial anesthesia is an advantage in ambulance [17], there are studies advocating that the anesthesia route is not effective.
