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 .
Hemodynamic Effects of Spinal Anesthesia in the Elderly: Single Dose Versus Titration Through a Catheter
Sixty elderly patients ( > 70 yr old ) undergoing surgery for hip fracture were prospect ively studied in order to compare hemodynamic tolerance of titrated doses of hyperbaric bupivacaine using continuous spinal anesthesia ( CSA ) versus single-dose spinal anesthesia ( SDSA ) . Patients were r and omized into two groups ( CSA group : n = 30 ; SDSA group : n = 30 ) . The SDSA patients received 10 - 15 mg of 0.5 % hyperbaric bupivacaine ( based on age and height ) , and the CSA patients received a starting dose of 5 mg of 0.5 % hyperbaric bupivacaine , followed after 15 min by optional reinjection of 2.5 mg every 5 min until a T10 level sensory block was reached . Onset of anesthesia , noninvasive hemodynamic variables and the need for ephedrine  were studied for 4 h after induction of anesthesia . Spinal anesthesia was successful in all patients . Decreases in mean arterial pressure were significantly less frequent and less pronounced in the CSA group ( 19.9 % + /- 1.6 % of the baseline value ) than in the SDSA group ( 40.2 % + /- 1.9 % , P < 0.0001 ) . The mean dose of ephedrine  was significantly less in the CSA group ( 1.8 + /- 0.7 mg , administered to only 37 % of patients ) than in the SDSA group ( 19.4 + /- 3.3 mg administered to all patients , P < 0.0001 ) . No late complications related to the spinal anesthesia technique were observed in either group . We concluded that CSA , using small titrated doses of 0.5 % hyperbaric bupivacaine , is safe , efficient , and provides better hemodynamic stability than SDSA in elderly patients . ( Anesth Analg 1996;82:312 - 6
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 .