Multimodal Perioperative Management of Elderly Hip Fracture Patients: Integrating Western and Traditional Chinese Medicine Approaches for Sleep, Pain, and PONV Control: A Narrative Review.

内容摘要

Hip fractures represent a significant global health burden in the elderly population, with perioperative complications substantially affecting morbidity and mortality. The triumvirate of postoperative pain, sleep disturbance, and postoperative nausea and vomiting (PONV) constitutes interconnected challenges that profoundly influence recovery trajectories in this vulnerable demographic. While Western medicine has established evidence-based protocols through Enhanced Recovery After Surgery (ERAS) frameworks and multimodal analgesia, Traditional Chinese Medicine (TCM) offers complementary therapeutic modalities with emerging evidence supporting their integration into perioperative care pathways. This narrative review synthesizes current evidence on Western and TCM approaches for managing sleep, pain, and PONV in elderly hip fracture patients, exploring mechanistic synergies and proposing an integrative framework for clinical implementation. We examine the neurobiological crosstalk between these three domains, evaluate contemporary Western interventions including peripheral nerve blocks and pharmacological prophylaxis, and critically appraise TCM modalities such as electroacupuncture, transcutaneous electrical acupoint stimulation (TEAS), and auricular therapy. The convergence of these therapeutic traditions offers promising avenues for optimizing perioperative outcomes while minimizing polypharmacy risks inherent to geriatric care. The proposed integrative protocol combines preoperative TCM conditioning, intraoperative peripheral nerve block with concurrent acupoint stimulation, and postoperative multimodal analgesia alongside acupuncture-based therapies, representing a phased clinical framework that targets multiple nodes of the pain-sleep-PONV neurobiological axis through complementary Western and TCM mechanisms. Future research directions emphasizing rigorous methodology and mechanistic investigations are proposed to advance this integrative paradigm.