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 .
Three-in-one femoral nerve block as analgesia for fractured neck of femur in the emergency department: a randomized, controlled trial.
STUDY OBJECTIVE We determine whether 3-in-1 femoral nerve block is effective as analgesia for fractured neck of femur when administered by emergency physicians . METHODS This was a prospect i ve , r and omized controlled trial with blinded assessors conducted in a district general hospital emergency department in the United Kingdom . Over a 6-month period , all patients with fractured neck of femur were considered for study . Patients were r and omly assigned to receive 3-in-1 nerve block with bupivacaine plus intravenous morphine or intravenous morphine . An accreditation package for all ED medical staff was devised to ensure competence in the technique of 3-in-1 nerve block .  Pain scores were recorded on arrival and at intervals up to 24 hours after admission .  Morphine consumption in the first 24 hours was recorded . RESULTS Ninety-four patients sustained fractured neck of femur during the study period ; 50 were studied . Of 44 not studied , 42 were confused , 1 did not consent , and 1 was overlooked . Patients receiving 3-in-1 nerve blocks recorded a faster time to reach the lowest pain score : 2.88 hours for patients with nerve block and 5.81 hours for control patients ( mean difference -2.93 h ; 95 % confidence interval [ CI ] -5.48 to -0.38 h ) . Nerve block recipients required significantly less morphine per hour than control patients ( mean of 0.49 mg/h versus 1.17 mg/h ; mean difference -0.68 mg/h ; 95 % CI -1.23 to -0.12 mg/h ) . CONCLUSION Three-in-one femoral nerve block is an effective method of providing analgesia to patients with fractured neck of femur in the ED . All grade s of medical staff were able to apply and consoli date this skill
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 .