Ultrasound-Guided Continuous Fascia Iliaca Compartment Block For Prophylactic Analgesia In Elderly Patients With Femoral Neck Fractures

Objective:The aim of this study is to investigate the comfort and effectiveness of ultrasound-guided continuous fascia iliaca compartment block(UCFICB)for prophylactic analgesia in elderly patients with femoral neck fractures,and to objectively evaluate its safety in terms of stress-related inflammatory factors and neurotransmitter factors.Methods:Using a randomized controlled trial design method,64 elderly patients who underwent elective unilateral hip arthroplasty(Total hip arthroplasty,THA)for femoral neck fracture in a tertiary care hospital in Jiangxi Province from December2021 to January 2023 were divided into two groups,with 32 patients in each group.In the control group,intravenous general anaesthesia + postoperative intravenous self-administered analgesia was used.The test group was UCFICB prophylactic analgesia combined with intravenous general anaesthesia + post-operative intravenous self-administered analgesia.The following data were measured,assessed and recorded for the test and control groups.1.Visual analogue scale(VAS)scores at rest and during movement after admission(T0),24 h after the block was administered/24 h after admission(T1)and at bed crossing on the day of surgery(T2).2.Intraoperative opioid consumption.3.number of postoperative analgesic pump presses.4.Minimental state examination(MMSE)scores at 24 h preoperatively(M1),24 h postoperatively(M2)and 72 h postoperatively(M3).5.Number of days in hospital.6.Peripheral blood serum interleukin-6(IL-6)levels and peripheral blood human brain-derived neurotrophic factor(BDNF)levels before(S1),at the end of surgery(S2)and 24 h after surgery(S3).Results:The study ended with a total of 64 patients completing all data collection,32 in the study group(2 dislodged and 2 excluded)and 32 in the control group(1dislodged).The results showed that.1.General data: There were no statistically significant differences between the two groups in terms of gender,age,ASA classification,intraoperative blood loss,duration of surgery and duration of anaesthesia(P>0.05).2.Perioperative pain evaluation: The difference in VAS scores at rest and during exercise at T0 was not statistically significant between the two groups of patients(P>0.05).Compared with the control group,there was no statistically significant difference in the comparison of VAS scores at rest at T1 and T2 in the test group patients(P>0.05),but the VAS scores during exercise at T1 and T2 in the test group patients were reduced(P<0.05).3.The total amount of sufentanil consumed during surgery,the total amount of remifentanil consumed,the number of intravenous self-administered analgesic pump presses after surgery and the number of days in hospital were all lower in the test group than in the control group(P<0.05).4.Comparison of cognitive status: Compared with patients in the control group,the MMSE scores of M1 were not statistically significant(P>0.05)and MMSE scores of M2 and M3 were higher(P<0.05)in the test group.5.Changes in IL-6 indicators: compared with the control group,the IL-6 levels in S1,S2 and S3 were lower in the test group(P<0.05).6.Changes in BDNF indicators: BDNF levels were higher in S1,S2 and S3 of patients in the test group compared with those in the control group(P<0.05).Conclusion:UCFICB prophylactic analgesia applied to elderly patients with femoral neck fractures reduces opioid use,shortens the number of days in hospital,reduces systemic inflammation levels,improves cognitive function and enhances patient comfort.