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 .
Pain treatment in post-traumatic hip fracture in the elderly: regional block vs. systemic non-steroidal analgesics
Background This prospect i ve , r and omized double-blind study , conducted over 19 months in a tertiary care ED , sought to determine if a fascia-iliaca regional anesthetic block provides better and safer pain relief than does parenteral analgesia . Aims This study also aim ed to determine the effectiveness of parenteral NSAID analgesia for acute hip fractures . Methods Patients > 65 years old presenting at an adult ED with acute hip fractures were r and omized upon presentation to the ED into two groups ( A and B ) using numbers generated by the EPI-INFO ™ ( Atlanta , GA : Centers for Disease Control and Prevention ) program . The r and omization list was kept by one of the authors who did not interact with the patients . Two groups of patients were to receive either ( A ) a fascia-iliaca block with bupivacaine and parenteral saline injection , or ( B ) the same block with saline and an IV NSAID injection . Upon admission to the study , vital signs such as blood pressure , mean blood pressure ( MAP ) , heart rate ( HR ) , respiratory rate ( RR ) and pain-intensity measurements [ using the Visual Analogue Scale ( VAS ) ] were obtained and repeated at 15 min , 2 h and at8 h. The occurrence of complications was registered . Results One hundred seventy-five patients were r and omized , and 21 were excluded from participation . The remaining 154 patients were grouped as : group A ( n = 62 ) or group B ( n = 92 ) . The mean pain level on admission to the ED for all patients , assessed with the VAS , was 8.21 ± 0.91 ( CI 95 % : 6.43–9.99 ) ; in group A the VAS was 7.6 ± 0.22 and in group B 8.5 ± 0.72 ( p = 0.411 ) . At 15-min evaluation , values were : group A 6.24 ± 0.17 and group B 2.9 ± 0.16 ( p < 0.001 ) . At the 2-h assessment , values were : group A 1.78 ± 0.11 and group B 2.3 ± 1.16 ( p = 0.764 ) . At 8 h the VAS for group A was 2.03 ± 0.12 and for group B 4.4 ± 0.91 ( p = 0.083 ) . Conclusion This study demonstrates that : ( 1 ) parenteral NSAIDs are very effective as analgesics after hip fractures in elderly patients , ( 2 ) fascia-iliaca regional blocks are nearly as effective for up to about 8 h after administration and ( 3 ) regional fascia-iliaca blocks effectively control post-hip fracture pain .  ( 4 ) Fascia iliaca regional block has a rapid onset
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 .