Guideline contains a list of the recommendations and the rating of strength based on the quality of the supporting evidence. Discussion of how each recommendation was developed and the complete evidence report are contained in the full guideline at www.aaos.org/ guidelines.

Background/Objectives Pain is universal, undertreated, and impedes recovery in hip fracture. This study compared outcomes for regional nerve blocks to standard analgesics following hip fracture. Design Multi-site randomized controlled trial from 4/2009-3/2013. Setting 3 New York hospitals. Participants 161 hip fracture patients. Intervention 79 patients were randomized to receive an ultrasound-guided single injection femoral nerve block administered by emergency physicians at emergency department admission followed by placement of a continuous fascia iliaca block by anesthesiologists within 24 hours. 82 control patients received conventional analgesics. Measurements Pain (0-10 scale), distance walked on post-operative day (POD) 3, Walking ability at 6 weeks following discharge, opioid side effects. Results Pain scores 2 hours following emergency department presentation favored the intervention group compared to controls (3.5 versus 5.3 respectively, P=.002). Pain scores on POD 3 were significantly better for the intervention as compared to the control group for pain at rest (2.9 versus 3.8, p=.005), with transfers out of bed (4.7 versus 5.9, p=.005), and with walking (4.1 versus 4.8, p=.002). Intervention patients walked significantly further than controls in 2 minutes on POD 3 (170.6 feet (95% CI 109.3, 232) versus 100.0 feet (95% CI 65.1, 134.9) respectively. P=.041). At 6 weeks, intervention patients reported better walking and stair climbing ability (mean FIM locomotion scores of 10.3 (95% CI 9.6, 11.0) versus 9.1 (95% CI 8.2, 10.0), P=0.045. Intervention patients reported significantly fewer opioid side effects (3% versus 12.4%, P=.028) and required 33-40% fewer parenteral morphine sulfate equivalents. Conclusion Femoral nerve blocks performed by emergency physicians followed by continuous fascia iliaca blocks placed by anesthesiologists are feasible and result in superior outcomes.

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