Overall , moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium .
Low-level evidence suggests that preoperative traction does not reduce acute pain .
Nerve blockade seems to be effective in reducing acute pain after hip fracture .
Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture .
BACKGROUND  Pain management  is integral to the management of hip fracture .
PURPOSE To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain  after hip fracture .
[Acute pain management in proximal femoral fractures: femoral nerve block (catheter technique) vs. systemic pain therapy using a clinic internal organisation model].
BACKGROUND The aim of this study was to compare safety and efficacy of catheter-mediated femoral nerve block analgesia with systemic pain therapy in patients with proximal femoral fractures in the pre-operative and post-operative setting using a protocol for coordinating pain management . METHODS In a prospect i ve r and omised trial of patients attending the emergency department , 100 individuals were selected with a clinical ly diagnosed proximal femoral fracture . Patients were divided into two equal groups A and B. Group A ( n=50 ) received a catheter-mediated femoral nerve block with 1 % prilocaine ( 40 ml ) and post-operatively 0.2 % ropivacaine ( 30 ml ) 6 hourly . Group B ( n=50 ) initially received intravenous metamizol ( 1 g ) and a fixed combination of oral tilidine ( 100 mg ) + naloxone ( 8 mg ) . Patients aged 90 years or more received a reduced dose ( tilidine 75 mg + naloxone 6 mg ) . In the post-operative period regular oral ibuprofen ( 400 mg , 8 hourly ) in addition to oral tilidine ( 50 mg ) + naloxone ( 4 mg ) was given as required for break through pain . Pain intensity was measured using a verbal rating scale ( VRS ) from 1 to 5 : pain free ( = 1 ) , mild pain ( = 2 ) , moderate pain ( =3 ) , severe pain ( = 4 ) , excruciating pain ( = 5 ) . Pain scores were recorded at rest ( R ) , during passive anteflection ( 30 degrees ) of the hip ( PA ) on arrival and at 15 and 30 min after initial administration of analgesia . Thereafter , recordings were made 4 times a day up to the third post-operative day . RESULTS Pain scores were comparable for both groups on admission ( VRS in R 2.50 vs. 2.46 ; VRS during PA 4.30 vs. 4.34 ) . Significant pain relief was achieved in both groups following initial administration of analgesia , but the total pain scores in group A were significantly lower than in group B ( VRS in R 1.22 vs. 1.58 , p<0.01 and VRS during PA 2.66 vs. 3.26 ; p<0.001 ) . No difference was noted between the two groups during the first 3 post-operative days . No severe complications occurred as a result of analgesia , however , the catheter was dislodged in 20 % of patients in group A result ing in the need for systemically administered analgesia . CONCLUSION All patients presenting with proximal femoral fractures should receive adequate analgesia within the emergency department even prior to radiographic imaging . Femoral nerve block should be considered as the method of choice . The insertion of a femoral nerve block catheter has the dual advantage of early analgesia permitting repeated clinical examination in addition to continued post-operative pain management . The cumbersome logistics inherent in this technique within the clinical setting limits its practical application . An initial single-shot regional nerve block followed by a systemic post-operative analgesia protocol was considered an appropriate alternative . The execution of safe , consistent and appropriate regional nerve block anaesthesia is reliant on formal guidelines and protocol s as agreed by the multidisciplinary teams involved with patient-directed pain management and good clinical practice
Overall , moderate evidence suggests that nerve blockades are effective for relieving acute pain and reducing delirium .
Low-level evidence suggests that preoperative traction does not reduce acute pain .
Nerve blockade seems to be effective in reducing acute pain after hip fracture .
Sparse data preclude firm conclusions about the relative benefits or harms of many other pain management interventions for patients with hip fracture .
BACKGROUND  Pain management  is integral to the management of hip fracture .
PURPOSE To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain  after hip fracture .