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 .
The impact of post-operative pain on outcomes following hip fracture
& NA ; Untreated pain is a major health care issue and very little is known about the treatment of pain and the effect of pain on post‐operative outcomes in older adults . This study was performed to identify the impact of pain on outcomes following hip fracture in older adults . Four hundred and eleven consecutive cognitively intact patients admitted with hip fracture to four New York hospitals were enrolled in a prospect i ve cohort study . Patients were interviewed daily using st and ardized pain assessment s. We used multiple logistic regression and ordinary least squares linear regression to examine the association of post‐operative pain on immediate post‐operative outcomes ( duration of stay , physical therapy sessions missed or shortened , ambulation following surgery , and post‐operative complications ) and outcomes 6 months following fracture ( locomotion , mortality , return to the community , residual pain ) . Patients with higher pain scores at rest had significantly longer hospital lengths of stay ( P=0.03 ) , were significantly more likely to have physical therapy sessions missed or shortened ( P=0.002 ) , were significantly less likely to be ambulating by post‐operative day 3 ( P<0.001 ) , took significantly longer to ambulate past a bedside chair ( P=0.01 ) , and had significantly lower locomotion scores at 6 months ( P=0.02 ) . Pain at rest was not significantly associated with post‐operative complications , nursing home placement , survival at 6 months , or residual pain at 6 months . Post‐operative pain is associated with increased hospital length of stay , delayed ambulation , and long‐term functional impairment . Whereas appropriate caution is warranted in administering opioid analgesics to older adults , these data suggest that improved pain control may decrease length of stay , enhance functional recovery , and improve long‐term functional outcomes
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 .