Clinical Value of Continuous Fascia Iliaca Compartment Block in Perioperative Management of Elderly Patients with Intertrochanteric Fracture: A Propensity Score-Matched Retrospective Study.

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2025-05-30 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S523883

Guoqiang Xu, Yuqing Deng, Hua Gao, Baojun Wang, Gang Wang, Ji Ma

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Abstract

Background: Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment block (CFICB) in perioperative management.

Methods: A retrospective analysis was conducted on elderly patients (≥65 years) with intertrochanteric fractures treated between January 2020 and December 2023. Eligible patients were initially divided into CFICB (n=46) and routine analgesia (RA, n=64) groups. Propensity score matching with a caliper width of 0.21 was performed, yielding 40 patients in each group for final analysis. Matching variables included age, gender, BMI, and ASA score. Primary outcomes were Visual Analog Scale pain scores, cognitive function assessed through a two-tier protocol (Montreal Cognitive Assessment [MoCA©] screening followed by confirmatory Mini-Mental State Examination-2 [MMSE-2Ⓡ] for positive screens), and functional recovery evaluated using the Harris Hip Score.

Results: The CFICB group showed significantly lower VAS scores during the early postoperative period (≤ 72h). This was most notable at 24 hours postoperatively (2.43 ± 0.72 vs 3.45 ± 0.87, P < 0.001). Postoperative cognitive dysfunction rates were significantly lower in the CFICB group. The differences were evident at 6h (10% vs 30%, P = 0.025), 24h (15% vs 35%, P = 0.039), and 72h (5% vs 20%, P = 0.043). Multivariable analysis identified CFICB as an independent protective factor against postoperative cognitive dysfunction (adjusted OR = 0.41, 95% CI: 0.26-0.65, P < 0.001). Harris Hip Scores at one month postoperatively were significantly higher in the CFICB group (78.56 ± 8.12 vs 72.39 ± 7.65, P = 0.008). Complication rates were comparable between groups (22.5% vs 17.5%, P = 0.576).

Conclusion: CFICB effectively improves postoperative pain management, reduces cognitive dysfunction incidence, and enhances early functional recovery in elderly patients with intertrochanteric fractures, while maintaining a favorable safety profile.

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连续髂筋膜间室阻滞在老年粗隆间骨折围手术期治疗中的临床价值：倾向评分匹配回顾性研究。

背景：老年患者髋部骨折是一个重大的医疗保健挑战，具有很高的发病率和死亡率。本研究探讨连续髂筋膜腔室阻滞（cfib）在围手术期治疗中的效果。方法：回顾性分析2020年1月至2023年12月治疗的老年（≥65岁）粗隆间骨折患者。符合条件的患者初始分为cfib组（n=46）和常规镇痛组（n= 64）。采用卡尺宽度0.21进行倾向评分匹配，每组40例患者进行最终分析。匹配变量包括年龄、性别、BMI和ASA评分。主要结果是视觉模拟量表疼痛评分，通过两层方案评估认知功能（蒙特利尔认知评估[MoCA©]筛查，阳性筛查后进行确认性精神状态检查-2 [MMSE-2Ⓡ]），并使用哈里斯髋关节评分评估功能恢复。结果：cfib组术后早期（≤72h） VAS评分明显降低。这在术后24小时最为显著（2.43±0.72 vs 3.45±0.87,P < 0.001）。cfib组术后认知功能障碍发生率明显降低。在6小时（10% vs 30%, P = 0.025）、24小时（15% vs 35%, P = 0.039）和72小时（5% vs 20%, P = 0.043）时差异明显。多变量分析发现cfib是预防术后认知功能障碍的独立保护因素（校正OR = 0.41, 95% CI: 0.26-0.65, P < 0.001）。术后1个月，cfib组Harris髋关节评分明显高于对照组（78.56±8.12 vs 72.39±7.65,P = 0.008）。两组间并发症发生率具有可比性（22.5% vs 17.5%, P = 0.576）。结论：cfib有效改善老年粗隆间骨折患者术后疼痛管理，降低认知功能障碍发生率，促进早期功能恢复，同时保持良好的安全性。

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.