Clinical Study Of Continuous Iliac Fascial Space Block In Postoperative Analgesia Of Intertrochanteric Fracture In Elderly Patients

To explore the effect of different concentrations of ropivacaine continuous iliac fascia compartment block（FICB）on the postoperative analgesia of elderly femoral intertrochanteric fractures.Discuss the effect of continuous FICB analgesia on cognitive function and stress,provide clinical reference for optimizing postoperative analgesia for elderly.PartⅠ:Comparative study of continuous iliac fascial space block analgesia after operation with different concentrations of ropivacaineObjective:To explore the effect of continuous FICB analgesia with different concentrations of ropivacaine on postoperative analgesia in elderly femoral intertrochanteric fractures.Methods:Eighty patients with femoral intertrochanteric fractures were selected,aged 65～89 years,BMI 18.5～25.0 kg/m²,ASA Ⅰ～Ⅲ,randomly divided into two groups:group A,group B,40 cases per group.Groups A and B received continuous FICB with 0.1%and 0.2%ropivacaine.Record the VAS at rest and exercise at 6h,12h, 24h,48h after operation;HR,MAP and SpO₂at 6h,12h,24h,48h after operation.Recorded tramadol salvage analgesia rate and adverse reactionsResults:（1）The VAS of group B was lower than group A at 6h,12h,24h,48h after operation（P<0.05）;（2）There was no difference in HR,MAP and Sp O₂at 6h,12h, 24h,48h in two groups（P>0.05）;（3）The rate of rescue analgesia tramadol and adverse reaction in group B within 48h was lower than group A（P<0.05）.Conclusion:0.2%ropivacaine continuous FICB is better than 0.1%ropivacaine in the analgesic of elderly,helpful for the recovery of patients.PartⅡ:The effect of intravenous analgesia and continuous iliac fascial space block on stress and postoperative cognitive in elderly femoral intertrochanteric fractures Objective: To explore the effect of continuous FICB analgesia and intravenous analgesia on stress and cognitive function in elderly femoral intertrochanteric fractures.Methods:Eighty patients with femoral intertrochanteric fractures were selected,aged65⁹0 years,BMI 18.5²4.0 kg/m2,ASA Ⅰ～Ⅲ,randomly divided into two groups:Intravenous analgesia control group（group C）,0.2% ropivacaine continuous pulse FICB group（group F）,40 cases per group.Record the VAS at 6h,12 h,24h,48 h after operation,postoperative tramadol salvage analgesia rate,adverse reactions;HR,MAP and Sp O2 at 6h,12 h,24h,48 h after operation;MMSE to assess the cognitive at preoperative 1d and 1d,3d,5d,7d after operation;ELISA to detect S100β and melatonin at preoperative 1d and 1d、3d、5d、7d after operation.Results:（1）The VAS of group F was lower than group C at 6h,12 h,24h,48 h after operation（P<0.05）;（2）The rate of tramadol salvage analgesia and adverse reactions in group F within 48 h after operation were lower than group C（P<0.05）;（3）There was no difference in HR,MAP and Sp O2 at 48 h in two groups（P>0.05）;（4）Compared with preoperative,MMSE and melatonin were decreased,S100β was increased at 1d and 3 d after operation（P<0.05）.Compared with group C,MMSE and melatonin were increased,S100β was decreased of group F at 1d and 3d after operation（P<0.05）.Conclusion: Continuous FICB in elderly femoral intertrochanteric fractures after surgery can provide better postoperative analgesia,reduce the rate of intravenous analgesics and adverse reactions,relieve stress and improve early postoperative cognitive function.