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 .
Minidose Bupivacaine–Fentanyl Spinal Anesthesia for Surgical Repair of Hip Fracture in the Aged
Background Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension . The synergism between intrathecal opioids and local anesthetics may make it possible to achieve reliable spinal anesthesia with minimal hypotension using a minidose of local anesthetic . Methods Twenty patients aged ≥ 70 yr undergoing surgical repair of hip fracture were r and omized into two groups of 10 patients each . Group A received a spinal anesthetic of bupivacaine 4 mg plus fentanyl 20 & mgr;g , and group B received 10 mg bupivacaine . Hypotension was defined as a systolic pressure of < 90 mmHg or a 25 % decrease in mean arterial pressure from baseline . Hypotension was treated with intravenous ephedrine boluses 5–10 mg up to a maximum 50 mg , and thereafter by phenylephrine boluses of 100–200 & mgr;g . Results All patients had satisfactory anesthesia . One of 10 patients in group A required ephedrine , a single dose of 5 mg . Nine of 10 patients in group B required vasopressor support of blood pressure . Group B patients required an average of 35 mg ephedrine , and two patients required phenylephrine . The lowest recorded systolic , diastolic , and mean blood pressures as fractions of the baseline pressures were , respectively , 81 % , 84 % , and 85%versus 64 % , 69 % , and 64 % for group A versus group B. Conclusions A “ minidose ” of 4 mg bupivacaine in combination with 20 & mgr;g fentanyl provides spinal anesthesia for surgical repair of hip fracture in the elderly . The minidose combination caused dramatically less hypotension than 10 mg bupivacaine and nearly eliminated the need for vasopressor support of blood pressure
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 .