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 .
Effect of Postoperative Epidural Analgesia on Rehabilitation and Pain after Hip Fracture Surgery: A Randomized, Double-blind, Placebo-controlled Trial
Background : Hip fracture surgery usually carries a high dem and for rehabilitation and a significant risk of perioperative morbidity and mortality . Postoperative epidural analgesia may reduce morbidity and has been shown to facilitate rehabilitation in elective orthopedic procedures . No studies exist on the effect of postoperative epidural analgesia on pain and rehabilitation after hip fracture surgery . Methods : Sixty elderly patients were included in a r and omized , double-blind study comparing 4 days of continuous postoperative epidural infusion of 4 ml/h bupivacaine , 0.125 % , and 50 & mgr;g/ml morphine versus placebo . Both patient groups received balanced analgesia and intravenous nurse-controlled analgesia with morphine . All patients followed a well-defined multimodal rehabilitation program . Pain , ability to participate in four basic physical functions , and any factors restricting participation were assessed on the first 4 postoperative days during physiotherapy . Results : Epidural analgesia provided superior dynamic analgesia during all basic physical functions , and patients were significantly less restricted by pain , which was the dominating restricting factor in the placebo group . Motor blockade was not a restricting factor during epidural analgesia . Despite improved pain relief , scores for recovery of physical independence were not different between groups . Conclusion : Postoperative epidural analgesia after hip fracture surgery provides superior analgesia attenuating pain as a restricting factor during rehabilitation without motor dysfunction . However , superior analgesia did not translate into enhanced rehabilitation . Future studies with multimodal rehabilitation are required to establish whether superior analgesia can be translated into enhanced rehabilitation and reduced morbidity in hip fracture patients
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 .