The Effects Of Continuous Fascia Iliaca Compartment Block On Patients Undergoing HIP Replacement With Femoral Neck Fracture

Objective:To investigate the influence of preoperative continuous fascia iliaca compartment block on patients undergoing hip replacement with femoral neck fracture about preoperative analgesia,intraoperative anaesthesia,postoperative analgesia,perioperative hemodynamics and stess response,assess patients satisfaction scales,observe catheter herniation and the adverse events about this procedure,thus to evaluate its efficacy and fesibality.Method:After approval by the hospital ethics committee and signature of the written informed consent,60 patients ASA physical status Ⅰ or Ⅱ with femoral neck fracture scheduled for unilateral total hip replacement(THR) were selected and randomly divided into two groups:group A(n=30) and group B(n=30).The patients in group A received continuous fascia iliaca compartment block at the inguinal region preoperatively.0.25% ropivacaine 0.5ml/kg was injected by the catheter as the initial dose.Both groups received combined spinal-epidural anesthesia(CSEA) at L2 and L3 level with the patients in lateral position, injured extremity on the upper side. Sedation was performed with propofol targeted control injection and 0.75% ropivacaine was given by epidural catheter according to the patients’ reaction during the operation.When the operation was finished,group A received patient controlled nerve analgesia(PCNA) with 0.25% ropivacaine 250ml,background infusion rate 5ml/h,each PC A 5ml,lockout time 30min,group B received patient controlled intravenous analgesia(PCIA) with sufentanil 0.05μg/kg/h,lappaconitine 0.4mg/kg,palonosetron 0.25mg,loading dose sufentanil 0.1 μg/kg,background infusion rate 2ml/h,each PCA 0.5ml,lockout time 15min, both lasted for 2 days.Pain was accessed using a visual analogue scale(VAS) at the moment of admission to operating room(T0) just before adjusting posture for CSEA(Tl),adjusting posture for CSEA(T2) and 4,8,12,24,48h postoperative,respectively.The volume and time when local anesthetic needed to give during the operation,blood pressure and heart rate at the time point of T0,T1,T2,5min after perforoming CSEA(T3),10min after skin incision(T4),60min after skin incision(T5),operation finished(T6) were all recorded.As indicators of stree response,blood glucose and serum cortisol were determined at T0、T4、T6、7 o’clock of the first day(POD1) and second day(POD2) postoperative,respectively.Catheter herniation and adverse events about the continuous fascia iliaca compartment block were also observed.Gross satisfaction was assessed.Complications occured during the first postoperative week,the days and cost spent in hospital were recorded. Results:At preoperative time point T1 and T2,the VAS scores were lower in group A than group B(P<0.05).There were no nerve block related side effects occured before performing CSEA, such as sensory and movement disorder,nausea and vomiting,somnolence,haematoma,vessel injection.Intraoperative local anesthetic consumption of ropivacaine was lower in group A than group B(3.0±1.7 ml vs. 5.5±1.1 ml,P<0.05),and the time when ropivacaine was needed to be given by epidural catheter was later in group A than group B(113.4±5.3 min vs.98.3±7.3 min,P<0.05).Group A showed significantly lower VAS scores during passive motion at each postoperative time point(P<0.05),there is no difference between two groups in VAS scores at rest after operation(P>0.05).Dezocine consumption in POD1,POD2 and in the two days were all lower in group A than group B(P<0.05).No motor nerve block cases occured in both groups.Gross satisfaction scales were higher in group A compared with group B(P<0.05).We found two cases with acupunture point red and swelling mildly when drawing the catheter.The incidence of other side effects such as dizziness,nausea and vomiting in group A was lower than group B(P<0.05).The level of MBP and HR at T1,T2,T3, blood glucose and cortisol at T4,T6,POD1,POD2 were all lower in group A than group B (P<0.05).Postoperative complications such as deep vein thrombolism,arrhythmia,postoperative cognitive dysfunction,gastrointestinal complication,the days and cost spent in hospital were all lower in group A than group B (P<0.05).Conclusion:For the patients with femoral neck fracture to be undergone hip replacement,preoperative continuous fascia iliaca compartment block can not only provide better pain relief around the time of adjusting posture for CSEA,add the effect of CSEA during the operation, but also control the postoperative pain more effectively with less side effects such as motor nerve block,nausea and vomiting,dizziness,and higher satisfaction sacales.It was favorable for the perioperative dynamics stablization,and can reduce the stress response level,further more,it can reduce the postoperative complications,the days and the cost spent in hospital.