Nerve blockade most effective option for managing pain after hip fracture

Nerve blockade is the most effective option for managing pain after hip fracture, according to a review funded by the Agency for Healthcare Research and Quality.

To determine the benefits and harms of pain management options after hip fracture, researchers performed a systematic review of 83 studies published from January 1990 to December 2010, including randomized, controlled trials, nonrandomized controlled trials, and cohort studies. Included studies had to involve adults at least 50 years of age and examine a pain management intervention for hip fracture. Such interventions included nerve blockade, spinal anesthesia, systemic analgesia, traction, multimodal pain management, neurostimulation, rehabilitation, and complementary and alternative medicine. The study results were published early online May 17 by Annals of Internal Medicine.

Study participants were mostly women (74%) and had a mean age ranging from 59 to 86 years. Thirty-one of the 83 studies excluded patients who had cognitive impairment or delirium. After review, the authors concluded that moderate evidence supported nerve blockade for relieving acute pain associated with hip fracture and preventing delirium. Preoperative traction was not found to reduce acute pain, but the evidence on this intervention was of low quality. The authors found insufficient evidence on the benefits and harms of spinal anesthesia, systemic analgesia, multimodal pain management, acupressure, relaxation therapy, transcutaneous electrical neurostimulation, and physical therapy for acute pain. They did conclude that according to the limited evidence available, acupressure, relaxation therapy, transcutaneous electrical nerve stimulation, and physical therapy seemed safe and might be effective for reducing pain.

The authors acknowledged that none of the included studies examined chronic pain outcomes or looked exclusively at nursing home residents or patients with cognitive impairment. In addition, they noted, systemic analgesics such as narcotics and NSAIDs were not adequately studied during the time period searched. However, the authors concluded that nerve blockade seems to be an effective method of controlling acute pain after hip fracture. Recommendations cannot be made on other interventions because of lack of evidence, they said.