The Effect Of Continuous Fascia Iliaca Compartment Block Analgesia Via Modified Approach On Delirium In Elderly Patients After Hiparthroplasty

Object: Postoperative delirium is a serious postoperative complication,especially in elderly patients with joint replacement.The effectiveness of continuous fascia iliaca compartment block for analgesia after hip arthroplasty has been extensively studied,but except the good analgesic effect,we do not know whether it has affects the occurrence of postoperative delirium.So we proceed a pilot study and conducted to investigate the effect of continuous fascia iliaca compartment block analgesia on postoperative delirium in elderly patients after hip arthroplasty.Methods: We enrolled 102 patients who underwent unilateral total hip arthroplasty and older than 65 years.Then they were randomized divided into study group and control group.The study group used continuous fascia iliaca compartment block to manage postoperative pain,and the control group used opioids to manage postoperative pain.Weevaluated the cognitive function of all patients on the first day before surgery using the mini-mental state examination;pain scores were assessed using Visual Analogue Score.At the same time,the levels of S100?,IL-6,IL-8 and TNF-? in the blood were measured.At 3h,6h,12 h,24h,and 48 h after the end of the operation,the Confusion Assessment Method was used to assess whether the patient developed delirium and VAS scale was used to re-evaluate pain.The blood levels of S100?,IL-6,IL-8 and TNF-? were measured again on the first day after surgery.Results: There were 19 patients developed delirium,14 in the control group(28%)and 5 in the study group(10%).There were no significant differences in IL-6,IL-8 and TNF-? between the two groups at different time points.The level of S100? in the blood of the study group was significantly lower than that of the control group after operation.The serum levels of S100?,IL-6,IL-8 and TNF-? in patients with postoperative delirium were significantly higher than those in patients without delirium.The scores of exercise pain in the study group were better than those in the control group at 24 h and 48 h after operation,and there was no significant difference between the two groups in the effect of different analgesic methods on pain at other time points.The overall hospital stay of the study group patients were lower than that of the control group.Conclusions: continuous fascia iliaca compartment block viamodified approach reduced the incidence of delirium in elderly patients after unilateral total hip arthroplasty.Accelerated postoperative rehabilitation of patients.