| Objective:To study the effect of fascia iliaca compartment block on perioperative analgesia and postoperative complications in geriatric patients with hip fractures.Methods:A total of 127 elderly patients undergoing hip fracture surgery from January 2021 to September 2021 were randomized to receive ultrasound-guided continuous fascia iliaca compartment block(group F)either intravenous analgesia control group(group C).Resting and exercising visual analog scales score were recorded at admission(T0),thirty minutes post-block(T1),the first day after admission(T2),the second day after admission(T3),adjusting position for spinal anaesthesia(T4),and 6 h(T5),24 h(T6)and 48 h(T7)postoperatively.MMSE scores and OAA/S scores were recorded on the day of admission,1 day before operation,1 day after operation and 3 days after operation.The perioperative trend of blood glucose level and hemodynamic indexes were observed to evaluate the stress response.Motor block was evaluated using modified Bromage score for lower extremity.The incidences of all postoperative complications and adverse reactions,including gastrointestinal reaction,dizziness and lethargy,pulmonary infection,delirium and deep venous thrombosis were recorded.The incidence of postoperative remedial analgesia,analgesia satisfaction and mortality within 30 days after operation were recorded.Results:1.General information:There was no significant difference between the two groups in age,gender,body mass index(BMI),ASA grade,age-adjusted Charlson comorbidity index(ACCI),fracture type,operation type and preoperative waiting day(P>0.05).The length of hospital stay in group F was shorter than that in group C(P<0.05).2.Perioperative pain evaluation:Compared with T0,the resting VAS score/exercise VAS score of T1～T7 in both groups decreased(P<0.05).Analysis showed statistically significant lower-rest VAS scores at T1、T4～T7 and lower-exercise VAS scores at T1～T7 in group F compared with group C(P<0.05).3.There was no statistically significant difference in the MMSE score and OAA/S score between two groups of patients on the day of admission(P>0.05).Compared with group C,the MMSE scores of group F were significantly higher at 12 hours before operation,1 day after operation and 3 days after operation(P<0.05).The OAA/S score of group F was higher than that of group C 3 days after operation(P<0.05).4.Bromage score of lower limb muscle strength:there was no significant difference in the modified Bromage score of affected limb motor block between the two groups at T1、T5～T7(P>0.05).5.Changes of stress indexes:there was no significant difference in blood glucose levels between two groups of patients at admission and one day before operation(P>0.05);Compared with group C,the blood glucose level during and one day after operation was lower in group F(P<0.05).Compared with group C,the mean arterial pressure in group F was lower at T4 time point,and the difference was statistically significant(P<0.05).The heart rate of group F at T1 was lower than that of group C(P<0.05).6.Adverse reactions of the two groups:there was no significant difference in the incidence of pulmonary infection,deep venous thrombosis and mortality within 30 days after operation between the two groups(P>0.05).The incidence of gastrointestinal reaction,dizziness,drowsiness and delirium in group F was lower than that in group C(P<0.05);7.Comparison of remedial analgesia and analgesic satisfaction between the two groups:the rate of remedial analgesia in group F was lower than that in group C(P<0.05).The satisfaction of perioperative analgesia in group F was higher than that in group C(P<0.05).Conclusion:Ultrasound-guided continuous fascia iliaca compartment block is an effective and safe way of providing analgesia for elderly patiatients with hip fracture,which can significantly reduce perioperative pain,decrease stress response,improve postoperative cognitive function,and reduce postoperative complications,thereby shortening hospital stay and improving the quality of life during hospitalization. |
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