Effects of S-ketamine and Continuous Iliac Fascia Space Block on Perioperative Neurological Cognitive Impairment and Postoperative Rehabilitation in Elderly Patients With Hip Fracture
Overview
- Phase
- Not Applicable
- Intervention
- S-Ketamine
- Conditions
- Hip Fractures
- Sponsor
- Yangzhou University
- Enrollment
- 108
- Locations
- 1
- Primary Endpoint
- incidence of peioperative neurocognitive impairment
- Last Updated
- 4 years ago
Overview
Brief Summary
Elderly patients with hip fracture are older and have a high incidence of perioperative complications. the postoperative recovery of elderly patients with hip fracture is affected by hemodynamic instability and pain caused by fracture. S-ketamine is the S-isomer of ketamine. Compared with traditional ketamine, S-ketamine has stronger analgesic effect and fewer adverse reactions of nervous system. The parasympathetic effect of S-ketamine can antagonize the circulatory inhibition of propofol and make the hemodynamics more stable in elderly patients with hip fracture.Iliac fascial space block (fasciailiacacompartmentblock,FICB) mainly depends on local anesthetics spreading to the femoral nerve, lateral femoral cutaneous nerve and obturator nerve in the iliofascial space to achieve analgesia in its dominant area. Ultrasound-guided iliac fascial space block can effectively reduce the amount of anesthetics and has shorter puncture time and fewer complications. It can more effectively reduce the perioperative pain of elderly patients with hip fracture.
Detailed Description
With the advent of the aging society, the incidence of hip fracture in elderly patients is increasing year by year, and the incidence of perioperative neurological cognitive impairment (PND) is increasing year by year. PND refers to postoperative brain dysfunction in patients without mental disorders, including postoperative delirium POD and postoperative cognitive dysfunction POCD. PND is more common in clinic, especially in the elderly. The main feature of PND is the long-term decline and decline of cognitive function after operation. PND not only prolongs the length of stay of patients, interferes with postoperative treatment, but even increases mortality. The pathogenesis of PND is not clear, and it is affected by many factors. Studies have shown that keeping intraoperative blood pressure at baseline to 10% above baseline can significantly reduce the incidence of PND. In addition, pain is also an important factor leading to the occurrence of PND. S-ketamine is the S-isomer of ketamine. Compared with traditional ketamine, S-ketamine has stronger analgesic effect and fewer adverse reactions of nervous system. The parasympathetic effect of S-ketamine can antagonize the circulatory inhibition of propofol and make the hemodynamics more stable. Iliac fascial space block (fasciailiacacompartmentblock,FICB) mainly depends on local anesthetics spreading to the femoral nerve, lateral femoral cutaneous nerve and obturator nerve in the iliofascial space to achieve analgesia in its dominant area. Ultrasound-guided iliac fascial space block can effectively reduce the amount of anesthetics and has shorter puncture time and fewer complications. In this study, a randomized controlled trial was conducted to observe the clinical effects of S-ketamine and ultrasound-guided iliac fascia block combined with general anesthesia in elderly patients with hip fracture, and to evaluate their clinical value.
Investigators
Yangtian Shuang
Resident physician
Yangzhou University
Eligibility Criteria
Inclusion Criteria
- •Clinical diagnosis of hip fracture
- •Aged 65 or above
- •No mental and nervous system diseases
- •No pathological fractures, such as bone tumor, bone tuberculosis, osteomyelitis, etc
- •No puncture site infection
- •No hospital stay for more than 48 hours after operation
Exclusion Criteria
- •Patients with severe cardiac, hepatic and renal dysfunction before operation
- •Long-term use of analgesics, sedatives and alcoholism
- •Patients with respiratory tract management difficulties (modified Ma's score is IV)
- •Previous neuropsychiatric diseases such as severe cerebrovascular, Alzheimer's disease, epilepsy and Parkinson's disease
- •Previous history of intracranial surgery or craniocerebral injury
- •Severe vision, hearing, language impairment or other reasons unable to communicate
- •Allergic or contraindicated to ropivacaine or non-steroidal anti-inflammatory drugs (NSAID)
- •Emergency surgery or trauma patients.
Arms & Interventions
Drug group
S-ketamine 0.1mg/kg was injected intravenously during anesthesia induction and esmolamine 0.1mg/ (kg.h) was injected intravenously during anesthesia maintenance.S-Ketamine was put into the analgesia pump as an adjuvant for continuous analgesia until 2 days after operation.
Intervention: S-Ketamine
Device group
The hip fracture was diagnosed clinically on admission and ultrasound-guided iliofascial space block was performed after evaluation, and the analgesia lasted until 2 days after operation.
Intervention: Continuous iliac fascia space block
Normal saline group
normal saline 0.1ml/kg was injected intravenously during anesthesia induction and normal saline 0.1ml/ (kg.h) was injected intravenously during anesthesia maintenance.normal saline was put into the analgesia pump as an adjuvant for continuous analgesia until 2 days after operation.
Intervention: Normal saline
Outcomes
Primary Outcomes
incidence of peioperative neurocognitive impairment
Time Frame: Perioperative period
incidence of peioperative neurocognitive impairment