The effect of fascia iliaca compartment block on postoperative delirium in elder adults undergoing hip surgery: A systematic review and meta-analysis of randomized controlled trials

IF 1.5 Q3 NURSING
Ran Duan, Longlu Cao, Huanhuan Zhang, Pan Li, Xiaoqian Wu, Jianli Li
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Abstract

Objective

This meta-analysis aimed to evaluate whether fascia iliaca compartment block (FIB) could reduce the incidence of postoperative delirium (POD) in elderly patients undergoing hip surgery.

Methods

This meta-analysis was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42023490399). The PubMed, Embase, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) till November 15, 2023. Review Manger 5.4 was used to analyze the data.

Results

A total of 10 RCTs with 930 elderly patients were included in this meta-analysis. This meta-analysis indicated that FIB could reduce the incidence of POD in elderly patients undergoing hip surgery without preoperative cognitive impairment (OR:0.46; 95%CI[0.22, 0.96], P = 0.04, I2 = 0%). Subgroup analysis of the incidence of POD showed that elderly patients who received FIB treatment before entering the operating room had a lower risk of developing POD(OR:0.48; 95%CI[0.30, 0.76], P = 0.002, I2 = 0%), and FIB could reduce the occurrence of POD in patients undergoing intravertebral anesthesia instead of general anesthesia (OR:0.37; 95%CI[0.20, 0.66], P﹤0.01, I2 = 0%). Moreover, FIB could reduce the MMSE score on the first day after surgery (SMD:1.07; 95%CI[0.15, 1.99], P = 0.02, I2 = 86%). In addition, FIB could reduce the pain score on the first and third day after surgery (SMD: -0.46; 95%CI[-0.74, -0.18], P = 0.001, I2 = 43%; SMD: -0.62; 95%CI[-0.97, -0.26], P﹤0.001, I2 = 58%), as well as after physical activity(SMD: -1.64; 95%CI[-3.00, -0.28], P = 0.02, I2 = 83%).

Conclusion

FIB can reduce the incidence of POD in elderly patients undergoing hip surgery without pre-existing cognitive impairment. Additionally, it can lower the delirium scores and pain scores.

髂骨筋膜室阻滞对接受髋关节手术的成年老年人术后谵妄的影响:随机对照试验的系统回顾和荟萃分析。
目的:本荟萃分析旨在评估髂筋膜室阻滞(FIB)能否降低接受髋关节手术的老年患者术后谵妄(POD)的发生率:该荟萃分析已在系统综述国际前瞻性注册中心(PROSPERO;CRD42023490399)注册。在PubMed、Embase、Web of Science和Cochrane Library数据库中检索了截至2023年11月15日的随机对照试验(RCT)。使用Review Manger 5.4分析数据:本次荟萃分析共纳入了 10 项随机对照试验,930 名老年患者。该荟萃分析表明,FIB 可降低接受髋关节手术且术前无认知障碍的老年患者的 POD 发生率(OR:0.46; 95%CI[0.22, 0.96], P = 0.04, I2 = 0%)。POD发生率的亚组分析显示,在进入手术室前接受FIB治疗的老年患者发生POD的风险较低(OR:0.48; 95%CI[0.30, 0.76], P = 0.002, I2 = 0%),FIB可减少接受椎管内麻醉而非全身麻醉患者的POD发生率(OR:0.37; 95%CI[0.20, 0.66], P﹤0.01, I2 = 0%)。此外,FIB 可以降低术后第一天的 MMSE 评分(SMD:1.07; 95%CI[0.15, 1.99], P = 0.02, I2 = 86%)。此外,FIB还能降低术后第一天和第三天的疼痛评分(SMD:-0.46;95%CI[-0.74,-0.18],P=0.001,I2=43%;SMD:-0.62;95%CI[-0.97,-0.26],P﹤0.001,I2=58%)以及体力活动后的疼痛评分(SMD:-1.64;95%CI[-3.00,-0.28],P=0.02,I2=83%):结论:FIB 可以降低接受髋关节手术且无认知障碍的老年患者的 POD 发生率。结论:FIB 可以降低无认知障碍的老年髋关节手术患者的 POD 发生率,还可以降低谵妄评分和疼痛评分。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
2.60
自引率
14.30%
发文量
34
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