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 .
A Comparison Between Lidocaine Alone and Lidocaine With Meperidine for Continuous Spinal Anesthesia
Background and Objectives . Experimental investigations have demonstrated a synergistic interaction between opioids and local anesthetics . This study aims to assess the effective benefit-risk ratio of continuous spinal anesthesia ( CSA ) induced with either 1.6 % lidocaine alone or in combination with 1 % meperidine . Methods . Thirty-four elderly patients ( 80.7 ± 7.3 years ) operated on for fracture of the neck of the femur were r and omly allocated to two groups . In the first group ( n = 15 ) , CSA was induced with lidocaine 1.6 % plain , whereas in the second group ( n = 19 ) 1 % meperidine was added . Reinjections were performed in both groups using lidocaine 1.6 % alone . Results . In the lidocaine group , 43 ± 13 mg was used for induction whereas in the other group the addition of 18 ± 5 mg of meperidine significantly reduced the dose of lidocaine required to 28 ± 8 mg ( p < 0.001 ) . Delay between two reinjections was increased to 51 ± 7 minutes in the lidocaine plus meperidine group , compared to 35 ± 6 minutes in the lidocaine group ( p < 0.001 ) . Ephedrine  was required for 9 out of the 19 patients in the lidocaine plus meperidine group , whereas it was required for only two patients in the other group ( p = 0.05 ) . Mean plasma concentrations of meperidine 1 hour and 3 hours after induction was 45.5 ± 12 ng/ml and 59 ± 22 ng/ml , respectively , and drowsiness was observed in 95 % of the patients in the second group . Delay before requirement for pain medication was 2.2 ± 2 hours in the lidocaine group and 14.1 ± 8 hours in the lidocaine plus meperidine group ( p < 0.001 ) . Conclusions . The association of 1 % meperidine with 1.6 % lidocaine during the induction of CSA decreases the initial induction dose , prolongs analgesia , produces initial drowsiness , and provides long-lasting pain relief . However , such benefits are offset by some impairment of hemodynamic stability that is likely to make this combination of drugs unacceptable as an enhanced analgesic technique
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 .