Fascia iliaca compartment block mitigates the fluctuations in heart rate variability and reduces pain with opioid consumption in elderly individuals with hip fractures: A randomized controlled trial

Abstract

BackgroundHip fractures, commonly known as the “terminal fracture of life,” frequently necessitate prompt surgical intervention and are accompanied by significant perioperative pain. ObjectiveThis investigation was performed to assess the impact of fascia iliaca compartment block (FICB) on heart rate variability during the perioperative period in elderly individuals with hip fractures. DesignSingle-center, randomized, controlled clinical trial. SettingThe study was conducted from September 2021 to February 2023 at one tertiary care hospital in China. ParticipantsPatients aged ≥60 years who underwent general anesthesia for hip fracture surgery were screened for enrollment. Eighty patients were initially assessed for eligibility, 70 underwent randomization, and 62 were included in the final analysis. MethodsPreoperatively, the patients were randomly allocated to either receive (Group F) or not receive (Group C) ultrasound-guided suprainguinal FICB. The primary endpoint was heart rate variability indicators at the corresponding time points. The secondary endpoints included the mean arterial pressure and heart rate measured at different time points [upon admission to the operating room (T1), during positioning (T2), at the time of skin incision (T3), 30 min after the start of surgery (T4), and 6 h postoperatively (T5)] and visual analogue scale (VAS) score, dose of oral pain medication over 24 h, and satisfaction scores were valued. ResultsCompared with Group C, Group F had a significantly reduced low-frequency band, high-frequency band, and low-/high-frequency band ratio at T3, T4, and T5 (P < 0.05). Group F also had a lower heart rate at T2, T3, T4, and T5 (P < 0.05). Moreover, Group F had lower flurbiprofen dosages at 24 h postoperatively (P < 0.05) and lower resting VAS scores at 6 and 24 h postoperatively (P < 0.05). ConclusionUtilization of ultrasound-guided FICB has the potential to yield efficacious analgesic effects, mitigate the pronounced fluctuations in heart rate induced by surgical stimulation, and maintain autonomic function stability to a certain degree.