Effect of fascia iliaca compartment block on postoperative delirium in elderly patients undergoing total hip arthroplasty / 中华麻醉学杂志

ABSTRACT

Objective:To evaluate the effect of fascia iliaca compartment block (FICB) on postoperative delirium in elderly patients undergoing total hip arthroplasty (THA).Methods:One hundred and two patients of both sexes, aged ≥ 65 yr, of American Society of Anesthesiologists physical status Ⅱ or Ⅲ, with body mass index ≤ 35 kg/m 2, undergoing elective THA under combined spinal-epidural anesthesia, were divided into 2 groups ( n=51 each) using a random number table method: FICB group and patient-controlled intravenous analgesia (PCIA) group.In group FICB, FICB was performed under ultrasound guidance after operation, 0.5% ropivacaine 30 ml (a loading dose) was given after successful insertion of the catheter, then the analgesic pump was connected, the analgesia solution contained 0.25% ropivacaine in 275 ml of normal saline, and the pump was set up with a 0.5 ml bolus dose, a 15 min lockout interval and background infusion at a rate of 5 ml/h.In group PCIA, the PCIA solution contained fentanyl 10 μg/ml in 100 ml of normal saline, and the pump was set up with a 1 ml bolus dose, a 10 min lockout interval and background infusion at a rate of 2 ml/h.Analgesia was maintained until 48 h after operation, and the visual analogue scale (VAS) score was maintained ≤4 in the two groups.When the VAS score was >4, the analgesic pump was pressed first followed by 10-20 min of observation.When the VAS score was still >4, flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.The Confusion Assessment Method was used to assess the development of delirium within 48 h after operation.The requirement for rescue analgesia and development of nausea and vomiting, urinary retention, constipation and pruritus were recorded within 48 h after operation.The serum concentrations of interleukin-6 (IL-6), IL-8, tumor necrosis factor-alpha and S100β protein were measured at 24 h before operation and 24 and 48 h after operation. Results:Compared with group PCIA, the incidence of postoperative delirium was significantly decreased after operation, the serum concentration of S100β protein was decreased at 24 and 48 h after operation ( P<0.05), and no significant change was found in the requirement for rescue analgesia, incidence of nausea and vomiting, urinary retention, constipation and pruritus after operation, and serum concentrations of IL-6, IL-8 and tumor necrosis factor-alpha at each time point in group FICB ( P>0.05). Conclusion:FICB can reduce the development of postoperative delirium in elderly patients undergoing THA.