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 .
TENS relieves acute posttraumatic hip pain during emergency transport.
BACKGROUND In Central Europe , ambulances for patients suffering from pain caused by nonlife-threatening trauma , such as hip fractures are staffed by medical personnel ( medics ) without physicians . Thus , there is an urgent need for nonpharmacological interventions that can be applied during the transport by basic life-support ( BLS ) medical personnel . METHODS In all , 101 patients were screened for participation in this r and omized placebo-controlled double-blind study , and r and omly assigned to two groups ( verum and sham transcutaneous electrical nerve stimulation [ TENS ] ) . First , medic A recorded all baseline parameters and measurements , then medic B performed TENS in absence of medic A. At the end of transportation , medic A performed data collection . Each patient was asked to grade his/her pain and anxiety level on visual analog scales ( VAS , 0 to 100 mm ) . RESULTS From 101 screened patients fulfilling the entry criteria , 29 declined consent and 9 had to be excluded from the analysis because of their final diagnosis . Therefore , the data from 30 patients ( group 1 , verum TENS ) as well as from 33 patients ( group 2 [ control ] , sham TENS ) were analyzed . No significant differences in potentially influencing factors were found before treatment . Pain scores upon arrival at the hospital differed significantly between group 1 and group 2 ( p < 0.01 ) . In group 1 , pain reduction was observed between departure from the site of emergency and arrival at the hospital ( VAS : 89 + /- 9 to 59 + /- 6 mm ) , whereas pain scores remained nearly unchanged in group 2 ( VAS : 86 + /- 12 to 79 + /- 11 mm ) . CONCLUSION Our findings show that TENS is a valuable and fast-acting pain treatment under the difficult circumstances of " out-of-hospital rescue " . Because of its lack of side effects , it could also be a valuable tool in the hospital
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 .