Effect Of Countinuous Iliac Fascia Compartment Block On Stress Response And Postoperative Delirium In Elderly Patients With Hip Fracture

Objective : To investigate the effect of preoperative ultrasound-guided continuous fascia compartment block(CFICB)on perioperative stress response and postoperative delirium in elderly patients with hip fracture.Methods : 80 elderly patients with hip fracture in our hospital,aged65-85,ASA grade Ⅱ-Ⅲ,were randomly divided into experimental group(F group)and control group(C group).The experimental group was given ultrasound-guided CFICB before operation;The control group was given routine analgesia before operation : intravenous injection of parecoxib,oral administration of parecoxib and tramadol sustainedrelease tablets.All patients were given intraspinal anesthesia,and postoperative continuous epidural block analgesia was performed.At admission(T1),1 hour after analgesia(T2),the moring of one day before operation(T3),the moring of operation day(T4),the moring of one day after operation day(T5)and the moring of two day after operation day(T6),resting and moving NRS scores were recorded.The occurrence of adverse reactions and remedial analgesia during analgesia in the two groups were observed and recorded.The heart rate and mean arterial pressure of the two groups at T1,T2,T3,T4,T5 and T6 were recorded;The venous blood of the two groups was collected at T1,T3 and T5 to detect the concentration of plasma glucocorticoid.After admission,the basic cognitive function of the patients was evaluated by Mini-Mental State Examination;Confusion Assessment Method was used to evaluate the occurrence of delirium on the day after operation,1d,3d,and 7d after operation.In addition,the preoperative waiting time,hospitalization time,and other perioperative complications of patients need to be observed and recorded.Results : There was no significant difference in gender,age,ASA grade,BMI index,MMSE score,operation method,operation time,intraoperative blood loss and preoperative waiting time between the two groups(P>0.05).The hospitalization time of group F was less than that of group C(P<0.05).At T2,T3 and T4,the resting and moving NRS scores of patients in group C were higher than those in group F(P<0.05).The times of rescue analgesia and the consumption of tramadol injection in group F were less than those in group C before operation(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).At T2,the heart rate of group F was lower than that of group C(P<0.05),and there was no significant difference between the two groups at the other time points(P>0.05).There was no significant difference in mean arterial pressure between the two groups at each time point(P>0.05).At T3,Plasma glucocorticoid concentration in group C was higher than that in group F(P<0.05).There was no significant difference in Plasma glucocorticoid concentration between the two groups at T1 and T5(P>0.05).Plasma glucocorticoid concentration in group F was lower than that in group C(P<0.05).The incidence of postoperative delirium in group C was higher than that in group F,but the difference between groups was not statistically significant(P>0.05).Conclusion : Continuous iliac fascia space block can reduce preoperative pain and stress reaction in elderly patients with hip fracture;There was no difference in the incidence of postoperative delirium between the two groups.