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 .
Efficacy of Preoperative Skin Traction in Hip Fracture Patients: A Prospective, Randomized Study
Objective To compare the analgesic benefit of preoperative skin traction with the placement of a pillow under the injured extremity in patients with hip fractures . Design Prospect i ve , r and omized clinical study . Setting University-affiliated teaching institution . Patients and Participants One hundred consecutive patients with hip fractures admitted to the authors ' institution who met inclusion criteria were enrolled . Fifty-five patients had femoral neck fractures , and forty-five patients had intertrochanteric fractures . The average patient age was seventy-eight years . Intervention All patients were preoperatively r and omized into two intervention groups . One group underwent placement of five pounds of skin traction on the injured extremity , whereas the second underwent placement of a pillow under the injured extremity . Fifty patients were enrolled in each intervention group . Results With respect to immediate postintervention pain levels , patients treated with a pillow showed a trend toward better pain relief , as compared with patients treated with skin traction ; however , this was not statistically significant . On the morning after admission , patients treated with a pillow had a statistically significant greater reduction in pain ( p = 0.04 ) . These patients also requested a statistically significant lower amount of pain medication ( p < 0.01 ) . Conclusions The authors think that preoperative skin traction in patients with hip fractures does not provide significant pain relief , as compared with pillow placement under the injured extremity , and thus should not be routinely performed in this patient population for analgesia
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 .