Effects Of Fascia Iliaca Compartment Block On Postoperative Early Sleep Function And Enhanced Recovery After Hip Fracture Surgery In Elderly Patients

Objective With the increasing of aging population,the population of elderly hip fracture patients is more and more.The advanced age,preoperative complications of cardiopulmonary diseases,and general anesthesia for elderly hip fracture patients are all independent risk factors for high postoperative complications and mortality.Therefore,hip fractures are also known as ‘the last fractures in life’.As it’s well-known,with the increasing of age,the sleep function for elderly patients becomes gradually decreasing.Pain will affect sleep,and poor sleep will worsen pain.It is particularly important how to manage perioperative analgesia,reduce stress response,improve sleep function,reduce postoperative complications,and promote rapid postoperative recovery for elderly hip fracture patients.In this study,we want to investigate the effects of ultrasound-guided fascia iliaca compartment block(FICB)combined with single spinal anesthesia on postoperative early sleep function and enhanced recovery after hip fracture surgery in elderly patients.Methods Eligible patients(n = 50),aged 65-85 years,BMI 18.5-30 kg /m2,ASA physical status Ⅱ or Ⅲ,scheduled for hip fracture surgery,were randomly divided into two groups(n = 25 in each group)using a random number table: single spinal anesthesia group(group SA)and fascia iliaca compartment block combined with single spinal anesthesia group(group FICB).Patients in group SA were received single spinal anesthesia after entering the room.Patients in group FICB were performed ultrasound-guided FICB after entering the room,and then received single spinal anesthesia.Pittsburgh sleep quality index(PSQI)was used to evaluate the sleep functions 1 d before and 1 d,3 d after operation.Postoperative sleep disturbance(POSD)was defined by the total score of PSQI ≥ 7.The incidences of POSD were compared between two groups.The visual analogue scale was used to evaluate pain intensity during rest and activity before operation(T0),at entering operation room(T1),changing body position(T2),6 h after operation(T3),12 h after operation(T4),24 h after operation(T5),48 h after operation(T6).Postoperative complications in two groups were recorded.The Harris hip score and the Barthel index were used to evaluate the functional recovery on 3 d after operation.The blood glucose level was measured by rapid glucose meter before anesthesia and before skin incision,30 min after operation,24 h after operation.The levels of plasma cortisol and melatonin were determined by enzyme-linked immunoassay(ELISA)before operation and 24 h after operation.Results Compared with the preoperative sleep function,the sleep function on 1 d,3 d after operation in both groups were significantly decreased.Compared with those on 1 d after operation,the sleep function on 3 d after operation in both groups were recovered.Compared with that of group SA,the sleep function in group FICB was decreased less on 1d after operation.Compared with that of group SA,the incidence of POSD in group FICB decreased significantly on 1d after operation(P < 0.05).The VAS pain scores during rest and activity in group FICB from T2 to T5 were significantly less than those in group SA(P < 0.05).The incidences of postoperative delirium and postoperative nausea and vomiting in group FICB were significantly less than those in group SA(P < 0.05).There was no significant difference in the Harris scores and the Barthel scores between the two groups(P > 0.05).The level of blood glucose in group FICB before skin incision was significantly less than that in group SA(P < 0.05).The level of plasma cortisol in group FICB was significantly less than that in group SA at 24 h after operation(P < 0.05).The level of plasma melatonin in group FICB was significantly higher than that in group SA at 24 h after operation(P < 0.05).Conclusion Fascia iliaca compartment block combined with single spinal anesthesia can relieve postoperative pain,decrease stress response,improve early sleep function,and have no significant effects on enhanced recovery after hip fracture surgery in elderly patients.