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 comprehensive hip fracture program reduces complication rates and mortality.
OBJECTIVES To evaluate the rate of postoperative complications , length of stay , and 1-year mortality before and after introduction of a comprehensive multidisciplinary fast-track treatment and care program for hip fracture patients ( the optimized program ) . DESIGN Retrospective chart review with historical control . SETTING Orthopedic ward ( 110 beds ) at a university hospital ( 700 beds ) . PARTICIPANTS Five hundred thirty-five consecutive patients aged 40 and older ( 94%>or=60 ) hospitalized for hip fracture between January 1 , 2003 , and March 31 , 2004 . Three hundred and thirty-six patients ( 70.3 % ) were community dwellers before the fracture and 159 ( 29.7 % ) were admitted from nursing homes . INTERVENTION The fast-track treatment and care program included a switch from systemic opiates to a local femoral nerve catheter block ; an earlier assessment by the anesthesiologist ; and a more- systematic approach to nutrition , fluid and oxygen therapy , and urinary retention . RESULTS In the intervention group , the rate of any in-hospital postoperative complication was reduced from 33 % to 20 % ( odds ratio=0.61 , 95 % confidence interval=0.4 - 0.9 ; P=.002 ) . Rates of confusion ( P=.02 ) , pneumonia ( P=.03 ) , and urinary tract infection ( P<.001 ) were lower in the intervention group than in the control group , and length of stay was 15.8 days in the control group , versus 9.7 days in the intervention group ( P<.001 ) . For community dwellers , 12-month mortality was 23 % in the control group versus 12 % in the intervention group ( P=.02 ) . Overall 12-month mortality was 29 % in the control group and 23 % in the intervention group ( P=.2 ) . CONCLUSION The optimized hip fracture program reduced the rate of in-hospital postoperative complications and mortality . R and omized clinical trials are needed to confirm these results and eluci date the elements of the program that have the greatest effect on clinical outcomes and mortality
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 .