Optimization Of Preoperative Analgesia For Hip Fracture In Elderly Patients:A Clinical Study

Objectives:Objective to optimize perioperative analgesia in elderly patients with hip fracture in enhanced recovery after surgery(ERAS).Method:The patients who underwent elective unilateral hip fracture surgery in our hospital from August 2017 to August 2018 were selected as the subjects.The inclusion criteria were as follows: age > 60,gender unlimited,ASAII or III grade,and those who underwent operation within 48 hours after admission were willing to sign the informed consent form.A total of 60 patients with hip fracture were included after excluding contraindications.They were randomly divided into two groups:combined nerve block analgesia group(group A,n=30)and traditional treatment group(group B,n=30).In the two groups,groups A was the treatment group,and group B was the control group.Group B was treated with intravenous injection of non-steroidal anti-inflammatory drugs and postural braking regimen.group A was treated with fascia iliaca compartment block immediately after admission on the basis of group B,continuous fascia iliaca compartment block was performed in 30 min before lumbar anesthesia on the day of operation and electronic analgesia pump was connected after operation.The pain degree of the two groups was evaluated one day before operation,during the examination before operation,during the posture before operation,and 12 hours,24 hours and 48 hours after operation.The changes of MAP and HR before operation and lumbar anesthesia posture,as well as the concentration of plasma CRP 1 day before operation and 1 day after operation were recorded.The sleep quality,the incidence of postoperative complications,the total hospital stay,the rate of remedial analgesia and the satisfaction of analgesia were evaluated 1 day before operation,1 day after operation,1 day,2 days and 3 days after operation.Result:There was no significant difference in general condition between the two groups(P > 0.05).There was no significant difference in pain score between the two groups at admission and 48 hours after operation(P > 0.05).Compared with group B,the pain scores of group A were lower than those of group B(P < 0.05).The pain scores of group A were lower than those of group B at the time of preoperative examination,during the position of spinal anesthesia before operation,12 hours and 48 hours after operation(P <0.05).There was no significant difference in preoperative MAP,HR and plasma CRP between the two groups(P > 0.05).The change of HR in group A was not significantly different from that in group B(P > 0.05).The plasma CRP concentration in group A was significantly lower than that in group B one day after operation(P < 0.05).The fluctuation of CRP in group A was significantly lower than that in group B(P < 0 05).The plasma CRP concentration in group A was significantly lower than that in group B one day after operation(P < 0 05).There was no significant difference in sleep quality between the two groups on the first day before operation and the third day after operation.The sleep quality in group B was significantly better than that in group B on the first and second day after operation(P < 0 05).There was no significant difference in sleep quality between the two groups on the first day before operation and the third day after operation.The incidence of adverse reactions,hospitalization days and remedial analgesia in group A were less than those in group B(P < 0.05),and the satisfaction of analgesia in group A was better than that in group B(P < 0.05).Conclusion:Combined nerve block analgesia can be safely and effectively used in hip fracture surgery,which can not only provide good perioperative analgesia,but also reduce stress and complications,and accelerate the rehabilitation of elderly patient with hipfracture.