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 .
Hemodynamic and Analgesic Effects of Clonidine Added Repetitively to Continuous Epidural and Spinal Blocks
Clonidine in spinal and epidural blocks prolongs anesthesia , but can cause hypotension and bradycardia . The aim of our study was to compare hemodynamic and analgesic effects of spinal versus epidural clonidine alone and after repetitive dosing . In a prospect i ve , r and omized , double-blind study , we evaluated 40 patients scheduled for lower extremity orthopedic surgery under continuous spinal or epidural anesthesia with bupivacaine 0.5 % ( initial dose 5 mg and 50 mg , respectively ) . In either spinal or epidural technique one-half of patients received clonidine ( 150 micro gram ) in addition to bupivacaine . Repeat doses of the same anesthetic mixture were allowed in cases of subsequent pain . Mean arterial pressure ( MAP ) and heart rate were recorded for 6 h after each injection . Duration of clinical ly useful anesthesia was defined as the time from drug administration to first sensation of pain . Intrathecal , but not epidural , clonidine decreased MAP significantly compared with bupivacaine alone . MAP after intrathecal clonidine with bupivacaine was lower than epidural clonidine with bupivacaine 5 and 6 h after injection . Repetitive administration caused no further decrease in MAP . Onset time required to surgical anesthesia ( sensory block of T11 ) did not differ among the four groups . Duration of spinal and epidural anesthesia was increased more than two fold by clonidine . In summary , the addition of clonidine prolongs analgesia by either route . These results may be explained by clonidine 's sites of action in hemodynamic control and the density of bupivacaine-induced block . ( Anesth Analg 1995;80:322 - 7
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 .