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 .
Three-in-One Blocks with Ropivacaine: Evaluation of Sensory Onset Time and Quality of Sensory Block
The purpose of this prospect i ve , r and omized , double-blinded study was to evaluate the sensory onset time and the quality of sensory block of ropivacaine , a new long-acting local anesthetic , compared with bupivacaine , for 3-in-1 blocks . Fifty ASA physical status I – III patients undergoing hip surgery after trauma were r and omly assigned to two study groups of 25 patients each . The two study groups received a 3-in-1 block with either 20 mL of ropivacaine 0.5 % or 20 mL of bupivacaine 0.5 % . Blocks in both groups were performed using a nerve stimulator .  The sensory onset time and the quality of sensory block was assessed by pinprick test in the central sensory region of each of the three nerves and compared with the same stimulation in the contralateral leg . We used a scale from 100 % ( normal sensation ) to 0 % ( no sensory sensation ) . We did not find significant differences in sensory onset times between the ropivacaine group and the bupivacaine group ( 30 ± 11 vs 32 ± 10 min ) . The quality of sensory blocks was also comparable between the study groups ( 19 % ± 20 % vs 21 % ± 15 % ) . We conclude that the sensory onset time and quality of sensory block during 3-in-1 blocks performed with ropivacaine are comparable to those with bupivacaine . Ropivacaine is described as being less potent than bupivacaine , making this local anesthetic promising for 3-in-1 blocks because of its reportedly lower incidence of cardiovascular and central nervous system complications . Implication s Ropivacaine 0.5 % has a sensory onset time and quality of sensory block during 3-in-1 blocks similar to that of bupivacaine 0.5 % . Ropivacaine is described as being less potent than bupivacaine , making it a promising local anesthetic for 3-in-1 blocks because of its reportedly lower cardiovascular and central nervous system toxicity
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 .