University of Alberta Evidence-based Practice Center, University of Alberta, Edmonton, Alberta, Canada.
Ann Intern Med. 2011 Aug 16;155(4):234-45. doi: 10.7326/0003-4819-155-4-201108160-00346.
Pain management is integral to the management of hip fracture.
To review the benefits and harms of pharmacologic and nonpharmacologic interventions for managing pain after hip fracture.
25 electronic databases (January 1990 to December 2010), gray literature, trial registries, and reference lists, with no language restrictions.
Multiple reviewers independently and in duplicate screened 9357 citations to identify randomized, controlled trials (RCTs); nonrandomized, controlled trials (non-RCTs); and cohort studies of pain management techniques in older adults after acute hip fracture.
Independent, duplicate data extraction and quality assessment were conducted, with discrepancies resolved by consensus or a third reviewer. Data extracted included study characteristics, inclusion and exclusion criteria, participant characteristics, interventions, and outcomes.
83 unique studies (64 RCTs, 5 non-RCTs, and 14 cohort studies) were included that addressed nerve blockade (n = 32), spinal anesthesia (n = 30), systemic analgesia (n = 3), traction (n = 11), multimodal pain management (n = 2), neurostimulation (n = 2), rehabilitation (n = 1), and complementary and alternative medicine (n = 2). 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. Evidence was insufficient on the benefits and harms of most interventions, including spinal anesthesia, systemic analgesia, multimodal pain management, acupressure, relaxation therapy, transcutaneous electrical neurostimulation, and physical therapy regimens, in managing acute pain.
No studies evaluated outcomes of chronic pain or exclusively examined participants from nursing homes or with cognitive impairment. Systemic analgesics (narcotics, nonsteroidal anti-inflammatory drugs) were understudied during the search period.
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.
Agency for Healthcare Research and Quality.
疼痛管理是髋部骨折管理的重要组成部分。
回顾髋部骨折后管理疼痛的药物和非药物干预措施的益处和危害。
25 个电子数据库（1990 年 1 月至 2010 年 12 月）、灰色文献、试验登记处和参考文献列表，无语言限制。
多位审查员独立并重复筛选了 9357 条引文，以确定针对急性髋部骨折后老年人疼痛管理技术的随机对照试验（RCT）；非随机对照试验（非 RCT）；和队列研究。
独立、重复的数据提取和质量评估，如果有分歧，则通过共识或第三位审查员解决。提取的数据包括研究特征、纳入和排除标准、参与者特征、干预措施和结果。
共纳入 83 项研究（64 项 RCT、5 项非 RCT 和 14 项队列研究），涉及神经阻滞（n=32）、椎管内麻醉（n=30）、全身镇痛（n=3）、牵引（n=11）、多模式疼痛管理（n=2）、神经刺激（n=2）、康复（n=1）和补充和替代医学（n=2）。总体而言，中等证据表明神经阻滞可有效缓解急性疼痛并减少谵妄。低水平证据表明术前牵引并不能减轻急性疼痛。关于大多数干预措施（包括椎管内麻醉、全身镇痛、多模式疼痛管理、穴位按压、松弛疗法、经皮神经电刺激和物理治疗方案）在管理急性疼痛方面的益处和危害的证据不足。
没有研究评估慢性疼痛的结果，也没有专门研究来自疗养院或有认知障碍的参与者。在搜索期间，系统镇痛剂（阿片类药物、非甾体抗炎药）的研究不足。
神经阻滞似乎可有效减轻髋部骨折后急性疼痛。关于许多其他髋部骨折患者疼痛管理干预措施的相对益处或危害的稀疏数据，无法得出明确的结论。
医疗保健研究和质量局。
