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 .
Spinal Anesthesia Using Single Injection Small-Dose Bupivacaine Versus Continuous Catheter Injection Techniques for Surgical Repair of Hip Fracture in Elderly Patients
Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia . We compared the hemodynamic effect of continuous spinal anesthesia ( CSA ) and small dose single injection spinal anesthesia ( SA ) regarding the incidence of hypotension . Seventy-four patients aged > 75 yr undergoing surgical repair of hip fracture were r and omized into 2 groups of 37 patients each . Group CSA received a continuous spinal anesthetic with a titration of 2.5 mg boluses every 15 min of isobaric bupivacaine , while group SA received a single injection spinal anesthetic with 7.5 mg of isobaric bupivacaine . The overall variations in noninvasive automated arterial blood pressure were not statistically significantly different in the 2 groups at baseline and after CSA or SA ( not significant ) . In the SA group , 68 % of patients experienced at least one episode of hypotension ( decrease in systolic arterial blood pressure greater than 20 % of baseline value ) versus 31 % of patients in the CSA group ( P = 0.005 ) . In the SA group , 51 % of patients experienced at least one episode of severe hypotension ( decrease in systolic arterial blood pressure more than 30 % of baseline value ) versus 8 % of patients in the CSA group ( P < 0.0001 ) . In the CSA group , 4.5 ± 2 mg of ephedrine was injected versus 11 ± 2 mg in the SA group ( P = 0.005 ) . In the CSA group , 5 mg ( 2.5–10 ) of anesthetic solution was required versus 7.5 mg in the SA group ( P < 0.0001 ) . We conclude that , in elderly patients undergoing hip fracture repair  , CSA provides fewer episodes of hypotension and severe hypotension compared with a single intrathecal injection of 7.5 mg bupivacaine
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 .