The Aerioperative Application Of Continuous Supra-inguinal Fascia Iliaca Compartment Block In Elderly Patients Undergoing Hip Fracture Surgery

Objective:To study the effect of ultrasound-guided continuous superior-inguinal fascia iliaca compartment block on perioperative analgesia and complications in elderly patients undergoing hip fracture surgery.Methods:70 patients undergoing unilateral hip fracture surgery were selected in our hospital from September 2018 to December 2019,aged from 60 to 85 years old,ASAⅡ、Ⅲ、Ⅳ level,or female.The patients were randomly divided into two groups:superior-inguinal fascia iliaca compartment block group(group S,n=35)and conventional analgesia group(group C,n=35).Group S: ultrasound-guided superior-inguinal fascia iliaca compartment block was performed during preoperative interview the day before surgery,30 ml of 0.3% ropivacaine was given,and nerve block catheter was placed,0.2% ropivacaine was continuously pumped with patient-controlled analgesia pump until into the operating room.Group C: routine preoperative preparation except nerve block.Both groups received unilateral hypobaric spinal anesthesia with 1.5～2.5 ml local anesthetics(2 ml of 1% ropivacaine mixed 1 ml of sterile water for injection)at the L(3-4)or L(2-3)lumbar interspace.Patients in group S received continuous nerve block analgesia with indwelling catheter until 48 hours after operation while the other group received patient controlled intravenous analgesia until 48 hours after operation.The VAS scores of rest(supine position)and passive movement(passive thigh raising 15 °)were recorded before block(T0),10 minute after block(T1),30 minute after block(T2),1 hour after block(T3),when entering the operating room(T4),2 hours after operation(T6),6hours after operation(T7),12 hours after operation(T8),24 hours after operation(T9),48 hours after operation(T10)and at the time of positioning(T5).The hemodynamic parameters of two groups of patients during T0～T10 were recorded.The incidence of adverse events such as dizziness,nausea and vomiting,drowsiness,respiratory depression(respiratory rate < 10 s/min),falls and urinary retention were recorded.The incidence of perioperative delirium,pulmonary infection and chronic postoperative pain were recorded.The Qo R-40 scale was used to evaluate the recovery of patients 24 hours after operation.The analgesic satisfaction score of the patients and postoperative length of stay was recorded.Results:1.Pain score: for intra-group comparison,the resting and passive movement VAS score in T5 were higher than T0 in group C(P < 0.05).In group S,the VAS scores of rest and passive movement at T1～T4 was lower than that at T0(P<0.05).The resting and passive movement VAS score of group S was lower than the group C at T2～T5(P<0.05).There was no significant difference in resting and passive movement VAS score between the two groups at T0,T1 and T6～T10(P >0.05).2.Comparison of hemodynamic indices:(1)Comparison of MAP: for intra-group comparison,In group C,the MAP at T4 and T5 was higher than that at T0(P<0.05).In group S,the MAP at T1 ～T3 was lower than that at T0(P<0.05).The MAP in the group S was lower than that in the group C at T2～T5(P<0.05).(2)Comparison of HR: for intra-group comparison,HR at T4 and T5 time point in group C was higher than that at T0 time point in group C(P < 0.05).In group S,the HR at T1 ～ T3 was lower than that at T0(P<0.05).The HR in the group S was lower than that in the group C at T2～T5(P<0.05).3.Comparison of postoperative complications: the number of nausea and vomiting and postoperative drowsiness in group C was significantly higher than that in group S,and the difference was statistically significant(P < 0.05).There was no significant difference in the incidence of dizziness,respiratory depression,falls and urinary retention between the two groups(P>0.05).There was no significant difference in the incidence of perioperative delirium,pulmonary infection and chronic pain(P > 0.05).4.Comparison of postoperative recovery: compared with the group C,the 24 h Qo R-40 scale scores and satisfaction scores in the group S were significantly lower(P < 0.05).There was no significant difference between the two groups in the length of stay(P>0.05).Conclusion:Ultrasound-guided continuous supra-inguinal fascial iliaca compartment block can reduce the pain and hemodynamic fluctuation caused by waiting for surgery and position placement,and can be applied to elderly patients of hip fracture with more stable hemodynamic,fewer adverse events and complications,and higher patient satisfaction.