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 .
Continuous psoas compartment block for anesthesia and perioperative analgesia in patients with hip fractures.
BACKGROUND AND OBJECTIVES The perioperative use of continuous psoas compartment block ( CPCB ) was compared with traditional pain management for patients with fracture of the femur . The anatomy of CPCB was also tested in cadavers . METHODS Forty consecutive patients ( range , 67 - 96 years old ) were prospect ively r and omized either to group A ( given local anesthetics using a CPCB ) or group B ( given perioperative analgesia with meperidine ) . In another part of the study , CPCB was performed in 15 fresh cadavers , and dissection of the lumbar region was performed after dye injection . RESULTS Continuous psoas compartment block was performed successfully in all patients in group A and was used in the pre- ( 16 - 48 hours ) and postoperative ( 72 hours ) periods . Visual analog scale score in group A was lower than in group B in 5/7 preoperative and 9/9 postoperative 8 hourly assessment s. Differences reached statistical significance ( P < .05 ) in 3 and 5 of the assessment s , respectively . Patient satisfaction was higher in group A in the pre- ( P < .05 ) and postoperative periods ( P<.03 ) . The block failed to achieve surgical anesthesia in 85 % ( 17/20 ) of the patients , and additional anesthesia was needed . The anatomic study failed to support the existence of a defined " psoas compartment " previously described , and supported the clinical findings . Injected dye was found in the region of the origin of the sciatic nerve ( essential for the production of anesthesia for hip surgery ) in only 26 % ( 4/15 ) of cadavers . CONCLUSIONS The CPCB seems to be an appropriate technique for efficient and safe perioperative pain control . However , in our dissections , the psoas compartment was not well defined in all patients , thus , using this route for anesthesia may result in only partial success
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 .