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 .
Relationship between pain and opioid analgesics on the development of delirium following hip fracture.
BACKGROUND Delirium and pain are common following hip fracture . Untreated pain has been shown to increase the risk of delirium in older adults undergoing elective surgery . This study was performed to examine the relationship among pain , analgesics , and other factors on delirium in hip fracture patients . METHODS We conducted a prospect i ve cohort study at four New York hospitals that enrolled 541 patients with hip fracture and without delirium . Delirium was identified prospect ively by patient interview supplemented by medical record review . Multiple logistic regression was used to identify risk factors . RESULTS Eighty-seven of 541 patients ( 16 % ) became delirious . Among all subjects , risk factors for delirium were cognitive impairment ( relative risk , or RR , 3.6 ; 95 % confidence interval , or CI , 1.8 - 7.2 ) , abnormal blood pressure ( RR 2.3 , 95 % CI 1.2 - 4.7 ) , and heart failure ( RR 2.9 , 95 % CI 1.6 - 5.3 ) . Patients who received less than 10 mg of parenteral morphine sulfate equivalents per day were more likely to develop delirium than patients who received more analgesia ( RR 5.4 , 95 % CI 2.4 - 12.3 ) . Patients who received meperidine were at increased risk of developing delirium as compared with patients who received other opioid analgesics ( RR 2.4 , 95 % CI 1.3 - 4.5 ) . In cognitively intact patients , severe pain significantly increased the risk of delirium ( RR 9.0 , 95 % CI 1.8 - 45.2 ) . CONCLUSIONS Using admission data , clinicians can identify patients at high risk for delirium following hip fracture . Avoiding opioids or using very low doses of opioids increased the risk of delirium . Cognitively intact patients with undertreated pain were nine times more likely to develop delirium than patients whose pain was adequately treated . Undertreated pain and inadequate analgesia appear to be risk factors for delirium in frail older adults
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 .