Postoperative Delirium Following Continuous Fascia Iliaca Compartment Block in Elderly Patients with Hip Fracture: A Case Series and Literature Review.

Abstract

Background: Postoperative delirium (POD) is a common complication in elderly patients with hip fracture. This study aimed to investigate the occurrence of POD in patients receiving continuous fascia iliaca compartment block (CFICB) with an opioid-containing solution, and review current evidence.

Case presentation: We retrospectively analyzed four elderly patients (aged 73-90 years) who developed delirium after receiving opioid-containing CFICB for hip fracture surgery. All received ultrasound-guided CFICB with ropivacaine 0.25% (loading dose 40mL) followed by continuous infusion (sufentanil 50μg + ropivacaine 100mg in 240mL saline at 3mL/h). The Montreal Cognitive Assessment (MoCA) was administered on admission. Patient characteristics were: Case 1 (73-year-old female, delirium onset postoperative day 4, MoCA = 26); Case 2 (90-year-old male, delirium onset postoperative day 2, MoCA = 18, surgery delayed 6 days); Case 3 (75-year-old male, delirium onset within 24 hours of surgery, MoCA = 28); Case 4 (87-year-old female, delirium occurred on the day of the block placement, MoCA = 15). Despite excellent post-CFICB pain control Visual Analog Scale (resting VAS ≤ 3) in all patients, delirium occurred, with durations ranging from 36 hours to 120 hours.

Conclusion: This small case series (n = 4) suggests that opioid-containing CFICB provides effective perioperative analgesia for elderly hip fracture patients but does not completely prevent postoperative delirium, particularly in patients with advanced age, baseline cognitive dysfunction, or delayed surgery. Given the retrospective design and small sample size, these findings are exploratory only. Larger prospective studies are needed.