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 .
Intravenous but Not Perineural Clonidine Prolongs Postoperative Analgesia After Psoas Compartment Block with 0.5% Levobupivacaine for Hip Fracture Surgery
We evaluated the systemic and local effects of clonidine as an analgesic adjunct to psoas compartment block ( PCB ) with levobupivacaine . In a r and omized , prospect i ve , double-blind trial , 36 patients requiring hip fracture surgery received PCB and general anesthesia .  Patients were r and omized into three groups . Each patient received PCB with 0.4 mL/kg of levobupivacaine 0.5 % . The control group ( group L ) received IV saline , the systemic clonidine group ( group IC ) received IV clonidine 1 & mgr;g/kg , and the peripheral clonidine group ( group C ) received IV saline and PCB with clonidine 1 & mgr;g/kg . The interval from time of completion of block injection to first supplementary analgesic administration was longer in group IC compared with group L ( mean ± sd , 13.4 ± 6.1 versus 7.3 ± 3.6 h ; P = 0.03 ) . There was no difference between group C and group L ( 10.3 ± 5.9 versus 7.3 ± 3.6 h ; P > 0.05 ) . The groups were similar in terms of 24 h cumulative morphine and acetaminophen consumption . There were no significant differences among groups regarding postoperative adverse effects ( bradycardia , hypotension , sedation , and nausea ) . We conclude that IV but not perineural clonidine ( 1 & mgr;g/kg ) prolongs analgesia after PCB without increasing the incidence of adverse effects
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 .