Effect Of Preoperative Pain Treatment On Perioperative Outcome Of Elderly Patients With Hip Fracture

Background and Objective:With the coming of the aging society,the proportion of the elderly is gradually increasing,and the health problems of the elderly are also exposed.Because the mental cognitive state of the elderly is significantly lower than that of the young adults and other reasons,it is very easy to fall injury and other accidents,resulting in fracture.Compared with other types of fracture,such as pathological fracture and old fracture,the damage of traumatic fracture is more serious.Among many categories of traumatic fracture in the elderly,especially hip fracture,the occurrence trend of traumatic fracture is increasing year by year.Traumatic fracture can lead to moderate to severe acute pain in patients,and pain,as one of the important factors affecting perioperative outcomes,has a significant impact on the quality of life and the level of treatment and rehabilitation of patients during the whole period of hospitalization.At present,among the perioperative pain of elderly patients with traumatic fracture,preoperative pain represented by the initial admission is the most serious.As far as the current situation of pain treatment in related fields is concerned,there is still a lack of sufficient attention and effective treatment strategies for preoperative pain.Nerve block analgesia will not lead to adverse reactions of NSAIDs and opioids.It is an analgesic method with simple operation,easy to master,clear mechanism and significant effect,and has been gradually included into the clinical and anesthesia system application considerations.This study attempted to explore the effects of preoperative pain treatment on perioperative life quality and recovery level of elderly patients with hip fracture,as well as cognitive function and survival and mortality after discharge by using preoperative nerve block and analgesia to improve patients’ pain level and reduce their pain level,so as to provide a new idea for perioperative management of elderly patients with fracture.Materials and Methods:Among the patients treated in the orthopedic treatment center of our hospital,60 patients who met the inclusion criteria were selected as the subjects of this study.The time frame is from May 2019 to December 2020.With the help of the Clinical Translational Center,this study was divided into two groups by random number method according to the different intervention measures: the experimental group was the preoperative pain treatment group(n = 29 cases),and the control group was the conventional treatment group(n = 30 cases).Patients in the experimental group were immediately asked to receive ultrasound guided continuous iliac fascial space block and analgesia treatment in the anesthesiology department after admission,while patients in the control group did not receive special treatment.The basic conditions of patients in the two groups during the perioperative period were observed and recorded :(1)the incidence of preoperative and postoperative nausea and vomiting;(2)Preoperative incidence of lower extremity deep vein thrombosis;(3)the number of additional cases of analgesic drugs;(4)Time interval between the end of the operation and the first time to go to the ground;The time interval from admission to surgery and the total length of hospital stay;(5)Case fatality rate after discharge;(6)VAS score,(7)Basic vital signs(blood pressure,heart rate,oxygenation);(8)Assessment of brain function,and assessment of POD occurrence in two groups within one week after surgery;(9)Sleep quality score;(10)The incidence of PND within six months after discharge.Results:Half an hour after nerve block treatment and 24 h before operation,the pain scores of the experimental group were significantly lower than that of the control group(P<0.05).There were no significant differences in the basic vital signs(mean arterial pressure,heart rate,oxygenation)between the two groups at the start of admission,30 minutes after block and 24 hours after operation(P>0.05).The number of patients receiving nerve block analgesia after admission to hospital in experimental group was significantly lower than that in control group;The incidence of nausea and vomiting in the experimental group was significantly lower than that in the control group before surgery,and there was no statistical difference after surgery(P<0.05).In terms of time interval from admission to operation day,time interval from operation end to postoperative ground movement and total hospital stay,the analysis results showed that the time of experimental group was significantly shorter than that of control group(P<0.05).Compared with the incidence of POD after operation,the analysis results of the first day and the second day after operation showed that the incidence of POD in the test group was significantly lower than that in the control group(P<0.05).The sleep scores of test group at 24 h after block and 24 h after operation were lower than those of control group(P<0.05).There was no significant difference in mortality and PND incidence between the two groups(P>0.05).Conclusion:Preoperative continuous nerve block analgesia can improve the perioperative sleep quality of elderly patients,shorten the waiting time,postoperative immobilization time,demand for analgesics,total hospital stay,and reduce the incidence of postoperative cognitive impairment and preoperative nausea and vomiting.However,there was no significant difference in the basic condition of operation(operation time and intraoperative infusion volume),the incidence of deep vein of lower extremities before operation,the incidence of postoperative nausea and vomiting,the survival rate within 6 months after discharge and the improvement of cognitive function.