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 .
Intrathecal Clonidine for Postoperative Analgesia in Elderly Patients: The Influence of Baricity on Hemodynamic and Analgesic Effects
Intrathecal ( IT ) clonidine is an effective analgesic , but it also produces hemodynamic depression and sedation which are likely to be related to IT clonidine ’s cephalad spread within the cerebrospinal fluid . We hypothesized that IT clonidine ’s side effects could be reduced without compromising the duration and quality of analgesia by injecting clonidine IT in a hyperbaric solution and elevating the patient ’s trunk . We prospect ively r and omized 30 elderly patients to receive IT150μ gofeitherisobaric(ISO ) or hyperbaric ( HYPER ) clonidine for postoperative analgesia after surgical repair of traumatichip fracture . Hemodynamics , IV fluid administration , visual analog pain scores , sedation scores , and clonidine cerebrospinal fluid levels were recorded at fixed intervals . Patients in the ISO group required significantly more crystalloid fluid administration ( median , 2500 mL ; range , 1500–3000 mL ) than those in the HYPER group ( median , 1500 ; range , 500–3000 mL ) to maintain adequate arterial blood pressure ( P < 0.01 ) . Also , the decrease in heart rate was significantly more pronounced in the ISO than in the HYPER group ( P < 0.01 ) . The duration of analgesia was significantly larger in the ISO ( median , 400 min ; range , 115–400 min ) than in the HYPER ( median , 265 min ; range , 205–400 min ) group ( P < 0.05 ) . Sedation scores did not differ between groups . We conclude that increasing the baricity of IT clonidine solution in the conditions of our experiment reduces hemodynamic side effects but also analgesia from IT administered clonidine
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 .