Anesthetic Effect of the Fascia Iliaca Compartment Block with Different Approaches on Total Hip Arthroplasty and Its Effect on Postoperative Cognitive Dysfunction and Inflammation

Abstract

ObjectiveThe objective of this article is to make a comparison of the anesthetic effects of the inside and outside fascia iliaca compartment block (FICB) in total hip arthroplasty (THA) and to study the effect of the different approaches of the FICB on postoperative cognitive dysfunction (POCD) and serum inflammatory cytokines in THA patients.MethodsA total of 60 patients who received THA treatment from January 2021 to December 2021 were divided into two groups, namely, Inside group (inside approach of the FICB) and Outside group (outside approach of the FICB), according to the different approaches of the FICB. Forty-eight hours after surgery, we compared the use of ropacaine dosage, visual analogue scale (VAS) score, the use of patient-controlled analgesia (PCA), mini-mental state examination (MMSE) score, the incidence of POCD, and the serum levels of IL-1, IL-6. Secondary indicators include surgical indicators and the quality of anesthesia cannula.ResultsThe ratio of re-fix the catheter, intubation time, and the use of ropacaine dosage at 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05), while the depth of cannulation in the Outside group was significantly lower than that in the Inside group (p < 0.05). VAS scores were comparable between the Inside and the Outside groups, except at 24 h after surgery. The use of PCA from 24 to 48 h after surgery in the Outside group was significantly higher than that in the Inside group (p < 0.05). The MMSE score and the incidence of POCD in the Outside group were higher than that in the Inside group. At the same time, the serum IL-1β levels at 1 and 6 h after surgery and the serum IL-6 levels at 1, 6, 24, and 48 h after surgery in the Outside group were significantly higher than that in the Inside group (p < 0.05).ConclusionCompared with the outside approach of the FICB, the inside approach of the FICB has better anesthetic effect, better postoperative analgesia, fewer postoperative analgesics, lower incidence of POCD, and lower serum cytokines during the treatment of THA patients.

Interactions and Trends of Interleukins, PAI-1, CRP, and TNF-α in Inflammatory Responses during the Perioperative Period of Joint Arthroplasty: Implications for Pain Management—A Narrative Review

“…Serum levels of IL-1β at 1 and 6 h post-surgery and IL-6 levels at 1, 6, 24, and 48 h were significantly higher in the Outside group than in the Inside group. The study concluded that the inside approach of the FICB demonstrated better anesthetic effectiveness, improved postoperative analgesia, reduced need for postoperative analgesics, lower incidence of POCD, and decreased serum cytokine levels in patients undergoing THA than the outside approach [237].…”

“…NLRP3 is a newly discovered factor associated with the progression of many diseases and may be related to inflammation [236]. Feng T. et al assessed the role of FICB and postoperative cognitive dysfunction and serum inflammatory cytokines in a recent published study on patients that underwent total hip replacement surgery [237]. All enrolled patients underwent general anesthesia with endotracheal intubation and an FICB that was performed with an ultrasound-guided inside approach (Inside group) or outside approach (Outside group).…”

“…A recently published study [237] aimed to compare the anesthetic effects of the inside versus outside approaches of FICB in THA patients, particularly focusing on postoperative cognitive dysfunction (POCD) and serum inflammatory cytokine levels. A total of 60 patients undergoing THA from January 2021 to December 2021 were divided into two groups based on the FICB approach: the Inside group and the Outside group.…”

Aplicación del bloqueo del nervio periférico de la cápsula de la cadera en analgesia temprana en pacientes ancianos con fractura de cadera

“…In the study, after blocking, PSQI and MMSE scores decreased in both groups, and PSQI score in group P was lower than that in group F, MMSE score in group P was higher than group F, revealing that the both blocks could improve the sleep quality of the elderly and play a certain protective effect on their neurological function, but the effect of PENG block was more significant. The possible mechanisms of the protective effect of nerve block on cognitive function are as follows: regional block can significantly reduce the dosage of general anesthesia drugs, reduce the concentration of inhaled anesthesia drugs, and thus, reduce the neurotoxic effects of general anesthesia drugs; regional block can reduce the stress of surgical trauma and pain on the whole body, inhibit the inflammatory response of the central nervous system, reduce the damage of the central nervous system, and thus protect the cognitive function 20 .…”

Clinical Effect of Application of Interventional Treatment Models for Improvement of Quality of Postoperative Recovery in Elderly Patients with Total Hip Arthroplasty

“… 14 Feng et al compared the effect of different approaches to the fascia iliaca compartment block on POCD in THA patients. 15 It has also been demonstrated that elderly patients with type A blood had a higher risk of developing early POCD than those with type O blood. 16 Nevertheless, little is known about the comprehensive intervention methods to reduce POCD in THA patients from various aspects.…”