Effect of perioperative continuous femoral nerve block on postoperative cognitive dysfunction in eld?erly patients with femoral neck fractures / 中华麻醉学杂志

ABSTRACT

Objective To evaluate the effect of perioperative continuous femoral nerve block on postoperative cognitive dysfunction(POCD)in elderly patients with femoral neck fractures. Methods Sixty American Society of Anesthesiologists physical statusⅡorⅢpatients of both sexes, aged 65-90 yr, scheduled for femoral head replacement under combined spinal?epidural anesthesia, were divided into 2 groups(n=30 each)using a random number table patient?controlled femoral nerve block for analgesia (PCNA)group and patient?controlled intravenous analgesia(PCIA)group. When the patients were diag?nosed with femoral neck fractures after admission to hospital in two groups, patients received continuous PCNA under nerve stimulator guidance until 48 h after operation in group PCNA, and fentanyl was continu?ously injected for analgesia until 48 h after operation in group PCIA. Neuraxial anesthesia was performed at L3,4interspace, 2 ml cerebrospinal fluid was extracted after successful subarachnoid puncture to detect the concentrations of Aβ?42 and tau, and the ratio of Aβ?42 to tau was calculated. The patient′s cognitive func?tion was assessed using Mini?Mental State Examination before analgesia and at 7 days after operation, and the occurrence of POCD was recorded. Results The ratio of Aβ?42 to tau in cerebrospinal fluid was signif?icantly lower, and the incidence of POCD was higher at 7 days after operation in group PCIA than in group PCNA(P<0.05). Conclusion Perioperative continuous femoral nerve block can decrease the develop?ment of POCD in elderly patients with femoral neck fractures.