Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study

Abstract

BackgroundPost-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block.MethodsA retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7–8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score.ResultsAdmission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27–2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS.ConclusionPost-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early post-operative cognitive performance in this population.

Fascia Iliaca Compartment Block for Perioperative Pain Management of Geriatric Patients with Hip Fractures: A Systematic Review of Randomized Controlled Trials

“…Outcomes showed that FICB had the highest probability of being the most effective against delirium. In a retrospective study comprising 959 patients aged over 65 years with a femoral neck fracture, Odor et al [ 62 ] investigated potential influence of FICB on postoperative abbreviated mental test scores (AMTS). Outcomes revealed that FICB use at admission was linked to significantly higher adjusted odds for a higher AMTS relative to lower AMTS than conventional analgesia method.…”

Improving Identification of Cognitive Impairment in Fragility Fracture Patients: Impact of Educational Guidelines on Current Practice

“…4,5 Inadequate analgesia has also been shown to negatively affect a patient’s AMTS, and regional analgesia has been found to reduce the risk of AMTS deterioration perioperatively. 15 Following hip fracture, patients with impaired cognition are less likely to return to their own homes or have successful rehabilitation. 1 Furthermore, hip fracture patients with delirium have been found to experience increased length of hospital stay and increased 1-year mortality, 5 and delirium superimposed on dementia is a strong predictor of functional dependence, institutionalization, and mortality.…”

“… 13 The AMTS is commonly used in Northern Ireland in the clinical setting 14 and has also been used in numerous studies assessing change in cognitive function among hip fracture patients. For example, Odor et al compared the impact of regional anesthesia on pre- and postoperative AMTS, 15 and Tahir et al used the AMTS on admission to assess baseline cognitive function when screening for postoperative delirium. 5 Thus, it has been suggested that, due to its brevity and sensitivity, the AMTS is a very useful screening test for elderly trauma patients to assess for impaired cognition of any cause.…”

Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures – effects on cognition

“…The risk of delirium increases with limited treatment of pain, so it is essential to provide good pain management [23]. Intermittent fascia iliaca compartment block (FICB) may reduce the incidence of delirium in patients with an intermediate risk of delirium [24] and preoperative FICB may also improve postoperative cognitive status [25]. Research indicates that nerve block is a good choice for pain control, especially in patients with cognitive impairment, as they have reduced abilities to describe their pain and their need for analgesia [26].…”