Elderly Patients Undergoing Hip Arthroplasty Research Articles

Effect of pericapsular nerve group block and suprainguinal fascia iliaca block on postoperative analgesia and stress response in elderly patients undergoing hip arthroplasty: a prospective randomized controlled double-blind trial

BackgroundAs a novel regional analgesic technique, ultrasound-guided pericapsular nerve group (PENG) block has some potential advantages, and we designed a randomized clinical trial (RCT) to investigate whether the ultrasound-guided PENG block combined with general anesthesia can better reduce stress response, maintain intraoperative hemodynamic stability, and reduce postoperative analgesia in elderly hip arthroplasty compared with ultrasound-guided suprainguinal fascia iliaca block (SIFIB) combined with general anesthesia.MethodsSeventy-four subjects were enrolled over an 8-month period (20 April 2023 to 31 December 2023). All patients were divided into the test group (group P) and the control group (group S) using the envelope as the randomization method. The test group was treated with preoperative ultrasound-guided PENG block analgesia combined with general anesthesia and the control group was treated with preoperative ultrasound-guided SIFIB analgesia combined with general anesthesia. The primary outcome selected was the patient Visual Analogue Scale (VAS) score at 12 h postoperatively.ResultsAfter generalized estimating equations (GEE) analysis, there was a statistically significant difference in the main effect of postoperative VAS score in group P compared with group S (P = 0.009), the time effect of VAS score in each group was significantly different (P < 0.001), and there was no statistically significant difference in the group-time interaction effect (P = 0.069). There was no statistically significant difference in the main effect of intraoperative mean arterial pressure (MAP) change (P = 0.911), there were statistically significant differences in the time effect of MAP in each group (P < 0.001), and there were statistically significant differences in the interaction effect (P < 0.001).ConclusionsIn summary, we can conclude that in elderly patients undergoing hip fracture surgery, postoperative analgesia is more pronounced, intraoperative hemodynamic parameters are more stable, and intraoperative stress is less induced in patients receiving SIFIB than in patients receiving PENG block.

Oral midodrine for prophylaxis against post-spinal anesthesia hypotension during hip arthroplasty in elderly population: a randomized controlled trial

BackgroundWe aimed to evaluate the efficacy of midodrine as a prophylaxis against post-spinal hypotension in elderly patients undergoing hip arthroplasty.MethodsThis randomized controlled trial included elderly patients undergoing hip arthroplasty under spinal anesthesia. Ninety minutes before the procedure, patients were randomized to receive either 5-mg midodrine or placebo (metoclopramide). After spinal anesthesia, mean arterial pressure (MAP) and heart rate were monitored every 2 min for 20 min then every 5 min until the end of the procedure. Post-spinal hypotension (MAP < 80% baseline) was treated with 10 mg ephedrine. The primary outcome was intraoperative ephedrine consumption. Secondary outcomes were the incidence of post-spinal hypotension, bradycardia, and hypertension (MAP increased by > 20% of the baseline reading).ResultsWe analyzed 29 patients in the midodrine group and 27 in the control group. The intraoperative ephedrine consumption was lower in the midodrine group than in the control group (median [quartiles]: 10 [0, 30] mg versus 30 [20, 43] mg, respectively, P-value: 0.002); and the incidence of intraoperative hypotension was lower in the midodrine group than that in the control group. The incidence of hypertension and bradycardia were comparable between the two groups.ConclusionThe use of 5 mg oral midodrine decreased the vasopressor requirements and incidence of hypotension after spinal anesthesia for hip surgery in elderly patients.Clinical trial registrationThis study was registered on September 22, 2022 at clinicaltrials.gov registry, NCT05548985, URL: https://classic.clinicaltrials.gov/ct2/show/NCT05548985.

The Analgesic Effects of Preemptive Ultrasound-Guided Pericapsular Nerve Group Block in Comparison with Erector Spinae Plane Block in Elderly Undergoing Hip Arthroplasty: A Randomized Controlled Trial.

Perioperative pain management strategies in the elderly undergoing hip arthroplasty need special and safe preemptive care. The primary aim of this study was to compare the analgesic effects of preemptive ultrasound-guided pericapsular nerve group (PENG) block and lumbar erector spinae plane block (L-ESPB) in the elderly undergoing hip arthroplasty. The time to the first postoperative rescue analgesia was measured. The secondary aim was to assess the ease of spinal positioning (EOSP), onset of sensory block, block performance time, and patient satisfaction. Before positioning for spinal anesthesia, 69 elderly patients undergoing hip arthroplasty were randomized into three groups (n = 23 per group). The first intervention group received ultrasound-guided PENG block with 20 mL bupivacaine 0.25%; the second intervention group received ultrasound-guided L-ESPB using the same dose of bupivacaine. In the control group, patients received spinal anesthesia without any block. The time to first postoperative rescue analgesic (morphine) was significantly prolonged in the PENG group (13.3 ± 3.5 h) compared to the L-ESPB (9.5 ± 2.3 h) and control (2.6 ± 0.4 h) groups. The EOSP score was significantly higher in the PENG group compared to the L-ESPB and control groups (P < 0.001). The block performance time and oneset of the sensory block were significantly shorter in the PENG group compared to the L-ESPB group. The highest patient satisfaction scores were observed in the PENG group. Preemptive pericapsular nerve group block postponed the need for postoperative analgesia and eased spinal positioning compared to L-ESPB in the elderly undergoing hip arthroplasty.

Correlation between preoperative frailty and postoperative delirium in elderly patients undergoing hip arthroplasty.

Postoperative delirium (POD) refers to acute brain dysfunction occurring within 7 days after operation or before discharge. Frailty refers to the state that the body's physiological reserve is insufficient, so that the compensative capacity to endogenous and exogenous stress stimuli decreases. The purpose of this study is to explore the association of preoperative frailty (PF) with POD in elderly patients undergoing hip arthroplasty. Totally 228 elderly patients (age ≥ 65 years) who received elective hip arthroplasty in the Ningbo No. 6 Hospital between December 2021 and June 2022 were enrolled. One day before surgery, the frailty phenotype scale was adopted for evaluation of patients' frailty. On the 1st-3rd day after operation, the confusion assessment method was adopted for evaluation of delirium, and the patients were grouped into a POD group and non-POD group. Logistic regression was conducted to analyze the correlation between PF and POD. Among the patients, the incidence of PF was 30.70% (70/228), and the incidence of delirium within 3 days after operation was 25.88% (59/228). According to binary logistic regression analysis, PF, age, hypertension, diabetes mellitus, and preoperative sleep disorder were independent risk factors for POD in elderly patients undergoing hip arthroplasty (all P < .05). PF is a crucial risk factor for POD in elderly patients undergoing hip arthroplasty.

Effect of subanesthetic dose of esketamine on postoperative rehabilitation in elderly patients undergoing hip arthroplasty

ObjectiveThe majority of individuals with femoral neck fractures opt for total hip replacement to enhance their quality of life. However, this group frequently exhibits perioperative symptoms of pain, anxiety, and sadness, which extends recovery time to some extent. Esketamine, the right-handed monomer of ketamine, is more popular these days due to its sedative, analgesic, and antidepressant properties. There are currently few domestic and international research on the use of esketamine in elderly individuals who have undergone surgery for a femoral neck fracture. In order to further cut the length of the hospital stay and hasten postoperative recovery, this study investigates whether esketamine postoperative analgesia can lessen postoperative pain, anxiety, and depression in older patients having hip replacement.Methods150 patients, ASA physical status I–II, aged ≥ 60 years, no limitation in gender, BMI 18–25 kg/cm2, who underwent selective total hip arthroplasty, according to random number table method, esketamine group (group A) and sufentanil group (group B) were randomized, 75 patients in each group. The two groups received general anesthesia method. At the end of the operation, PCIA was connected for analgesia. In group A, esketamine 2.5 mg/kg was mixed with normal saline to 100 ml. In group B, sufentanil 2.5 ug/kg was mixed with normal saline to 100 ml. Record the VAS scores after operation. Record the first ambulation time, ambulation distance and Patient-controlled Analgesia compression times after operation. The incidence of postoperative adverse reactions such as drowsiness, dizziness, nausea and vomiting, multilingual were recorded. ELISA was used to detect IL-6 and CRP in the morning, 24 h and 72 h after operation. The Hospital Anxiety and Depression Scale (HAD) score and Harris score at 3 days, 1 week and 1 month after operation were followed up.ResultsThere was no significant difference in VAS score and PCA compression times (P > 0.05), but the incidence of nausea, vomiting and dizziness in group B was higher than that in group A (P < 0.05). Compared with group B, the levels of IL-6 and CRP in group A at 24 h and 72 h after operation were significantly decreased (P < 0.05). Postoperative ambulation time and ambulation distance in group A were better than those in group B (P < 0.05). The HAD score of group A was lower than that of group B at 3 days and 1 week after operation (P < 0.05). However, there was no significant difference between the two groups at 1 month after operation (P > 0.05). The Harris score of group A was higher than that of group B at 3 days, 1 week and 1 month after operation (P < 0.05).ConclusionsEsketamine can reduce short-term postoperative anxiety and depression, relieve postoperative pain and stress response, shorten bed rest time after total hip replacement, and accelerate postoperative recovery.

Perioperative Nursing Progress of Elderly Patients Undergoing Hip Arthroplasty

Perioperative Nursing Progress of Elderly Patients Undergoing Hip Arthroplasty

Study on Therapeutic Application of Huangqi Combined with Staged Care in Elderly Patients

To investigate the clinical effects of huangqi Bazhen decoction combined with traditional Chinese medicine staged rehabilitation care on elderly patients undergoing hip arthroplasty. A total of 200 elderly patients who underwent hip arthroplasty in our hospital from January 2020 to December 2021 were selected and divided into routine group (100 patients) and rehabilitation group (100 patients) according to random number table method. Routine nursing was given to patients in the routine group and huangqi decoction combined with traditional Chinese medicine staged rehabilitation care was given to patients in the rehabilitation group, to compare the effects of the application in the two groups. Compared with preoperative values, Harris scores were significantly higher at 4 w and 8 w postoperatively in both groups, and the scores of the rehabilitation group were higher and significantly different from those of the routine group (p<0.05); the rehabilitation group had a higher rate of excellent hip joint than the routine group, and the difference was significant (p<0.05); all the scores on the short form-36 scale in the two groups after intervention were higher than those before intervention and those of the rehabilitation group were higher than those of the routine group, with significant differences (p<0.05); the rehabilitation group had a lower incidence of postoperative complications than the routine group (p<0.05). The combination of huangqi Bazhen decoction and traditional Chinese medicine staged rehabilitation care can promote postoperative hip recovery in elderly patients undergoing hip arthroplasty, reduce the incidence of complications such as postoperative lower extremity deep vein thrombosis and improve the quality of life of patients.

Predictors of Chronic Postsurgical Pain in Elderly Patients Undergoing Hip Arthroplasty: A Multi-Center Retrospective Cohort Study.

BackgroundIdentifying patients at high risk of developing chronic postsurgical pain (CPSP) is of extreme importance in order to help launch appropriate therapeutic strategies and intensive initiation of pain management.AimIn this study, we aimed to conduct a multi-center retrospective cohort study to establish a prognostic model and a nomogram to predict the risks of CPSP in elderly patients who underwent hip arthroplasty at 6 months postoperatively.MethodsWe collected data from 736 patients aged >65 years who had undergone hip arthroplasty from October 1, 2016 to September, 30, 2018 at multiple tertiary referral centers in Guangzhou, China. All data were randomly stratified into a training set and a testing set at a ratio of 8:2. Data were analyzed via multiple logistic regression analysis with receiver operating characteristic (ROC) curves and areas under the curve. This model was further validated by estimating calibration and discrimination. A nomogram was ultimately developed.ResultsA total of 736 eligible patients were enrolled, 27.20% of whom developed CPSP within 6 months postoperatively. Preoperative pain in the surgical area (OR=2.456, 95% CI:1.814–3.327, P<0.001), preoperative depression state (OR=1.256, 95% CI:1.146–1.378, P<0.001), surgical type (OR=7.138, 95% CI:3.548–14.364, P<0.001), acute postoperative numerical rating scale score (OR=5.537, 95% CI:3.607–8.499, P<0.001) and analgesic type (patient-controlled epidural analgesia: OR=0.129, 95% CI:0.055–0.299, P<0.001; patient-controlled intravenous analgesia: OR=0.033, 95% CI:0.011–0.097, P<0.001) were identified as independent significant factors associated with CPSP. A prognostic model was established and further validated. An ROC curve confirmed the predictive ability of this model with a high sensitivity value of 92.12% (95% CI:86.90–95.74) and specificity value of 91.72% (95% CI:88.77–94.11). A nomogram was developed to simplify the use of the predictive model in clinical practice.ConclusionThis prognostic model could be of great value in clinical practice, serving as the basis for early personalized analgesic management of elderly patients undergoing hip arthroplasty.

Impact of edaravone on serum CXC chemokine ligand-13 levels and perioperative neurocognitive disorders in elderly patients with hip replacement.

Background:Perioperative neurocognitive disorders (PND) are a series of severe complications in the perioperative and anesthetic periods with a decline in memory, execution ability, and information processing speed as the primary clinical manifestation. This study aimed to evaluate the impact of edaravone (EDA) on PND and peripheral blood C-X-C motif chemokine ligand 13 (CXCL13) levels in elderly patients with hip replacement.Methods:A total of 160 elderly patients undergoing hip arthroplasty in Affiliated Dongguan People's Hospital of Southern Medical University (from March 2016 to March 2018) were randomly and double-blindly categorized into an EDA group and a control group (CON). Group EDA was administered intravenously EDA 30 min before surgery, and group CON was administered intravenously saline. The cognitive function of the two groups was evaluated 1-day before the operation and at 1 and 12 months after surgery, and the incidence of post-operative delirium was tested on days 1, 3, and 7 after surgery using the Chinese version of the confusion assessment method. Serum CXCL13 and interleukin (IL)-6 concentrations were measured before anesthesia, during surgery (30 min after skin incision), and on days 1, 3, and 7 after surgery. The continuous variables in accordance with normal distribution were tested using the Student's t test, the continuous variables without normal distribution using the Mann-Whitney U test, and categorical variables by the χ2 test or Fisher exact test.Results:The incidence of post-operative delirium within 7 days after surgery was significantly higher in group CON than that in group EDA (31.3% vs. 15.0%, t = −5.6, P < 0.001). The modified telephone interview for cognitive status and activities of daily life scores were significantly higher in the group EDA than those in the group CON at 1 month (39.63 ± 4.35 vs. 33.63 ± 5.81, t = −2.13, P < 0.05 and 74.3 ± 12.6 vs. 61.2 ± 13.1, t = −1.69, P < 0.05) and 12 months (40.13 ± 5.93 vs. 34.13 ± 5.36, t = −3.37, P < 0.05 and 79.6 ± 11.7 vs. 65.6 ± 16.6, t = −2.08, P < 0.05) after surgery; and the incidence of neurocognitive dysfunction was significantly lower in the group EDA than that in the group CON (P < 0.05). Serum CXCL13 and IL-6 concentrations were significantly lower in the group EDA than those in the group CON during and after surgery (P < 0.05).Conclusion:EDA can significantly reduce the serum concentrations of CXCL13 and IL-6 and improve the PND of patients.

Evaluation of Light Specific Gravity Ropivacaine Combined with Sufentanil in Hip Arthroplasty at An Advanced Age

Objective: To observe the effect of light specific gravity ropivacaine combined with sufentanil in elderly patients undergoing hip replacement. Methods :89 elderly patients with hip arthroplasty from July 2019 to September 2020 were randomly divided into experimental group and control group. The experimental group was anesthetized with light specific gravity ropivacaine combined with sufentanil. The control group was anesthetized with equal specific gravity ropivacaine to compare the effect of anesthesia and the incidence of adverse reactions. Results: there was no significant difference in sensory recovery time and motor recovery time between the experimental group and the control group (P&gt;0.05), and the incidence of adverse reactions between the two groups was low. The sensory block time in the experimental group was shorter than that in the control group (PP&gt;0.05). Conclusion: ropivacaine combined with sufentanil subarachnoid anesthesia is more effective in elderly patients undergoing hip arthroplasty, and the safety of the anesthesia scheme is higher, which will not lead to serious adverse reactions during operation. Moreover, the application of the anesthesia scheme can effectively improve the analgesic effect during and after operation, and the clinical application value is high.

An Analysis for the application of rapid rehabilitation surgery concept in the nursing satisfaction of the perioperative period of the elderly’s hip arthroplasty

Objective To explore the application of rapid rehabilitation surgery concept in the nursing satisfaction of the perioperative period of the elderly’s hip arthroplasty. Methods To select 58 cases of elderly patients undergoing hip arthroplasty in our hospital from March 2017 to February 2018 as the research subjects. The patients were randomly divided into the experimental group and the control group by number table method and there were 29 cases per group. The patients in the experimental group were in the nurse of the concept model of rapid rehabilitation surgery, while the patients in the control group were in the routine nurse of perioperative period. Results After the comparison of hip joint function recovery score, operation time and hospitalization time between the two groups of patients, the advantages of hip function recovery score, operation time, and hospitalization time in the experimental group were obvious statistically significant(P&lt;UNK&gt; 0.05). Compared with the patients in the control group, the nursing satisfaction of the patients in the experimental group was higher and statistically significant(P&lt;UNK&gt; 0.05). Conclusion The concept of rapid rehabilitation surgery is effective for the elderly patients with hip arthroplasty, which can promote the rehabilitation of patients and improve the nursing satisfaction of patients. It is of great significance to improve the relationship between nursing patients.

Postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty.

Even after successful hip arthroplasty, elderly patients who have undergone this procedure remain subject to cognitive decline and may collectively develop postoperative cognitive dysfunction (POCD). However, no consensus exists as to the risk factors resulting in a higher likelihood that a patient may present with this complication, and the aetiology of POCD is not well understood. We conducted a systematic review of papers concerning the influence of POCD-related risk factors in patients undergoing hip arthroplasty but limited the literature search to papers in English. A systematic and electronic search for manuscripts in the PubMed database was performed in order to identify all studies in which the risk factors for POCD were investigated. Articles were also obtained from the authors' files. Keywords for the search were postoperative cognitive dysfunction/change/impairment/decline/deficit, elderly/older/aged patients, and hip arthroplasty/replacement surgery. The evidence published to date suggests that POCD is a multifactorial disease, which includes an individual patient's characteristics, surgery, type of anaesthesia, and pain levels. All of these factors can increase the risk of POCD incidence. There are a number of factors that appear to influence the risk of early cognitive dysfunction after hip arthroplasty. Nevertheless, the specific mechanism and explicit risk factors associated with this cognitive dysfunction are not completely understood. Hip arthroplasty has made it possible for older patients to find relief from pain and improve their function, whereas it also increases the risk for suffering POCD that may affect these patients' quality of life and increase their mortality. Therefore, it is worthwhile investigating the mechanism of POCD in future studies in order to prevent and treat this condition.

Establishment and analysis of predictive models of postoperative complications in elderly patients undergoing hip arthroplasty

Objective To establish a preoperative evaluation model and evaluate the accuracy of postoperative complications by analyzing the risk factors of postoperative complications in hip arthroplasty in elderly patients, and to provide a basis for grading nursing. Methods From January 2012 to August 2018, 148 patients with elderly patients undergoing hip arthroplasty admitted to People′s hospital of Wanning were included in the study. Among them, 23 patients with postoperative complications were included as complications and 125 patients without complications served as a control group. Univariate analysis of the factors associated with complications, statistically significant indicators were included in the multivariate logistic regression model, and the risk factors for postoperative complications in hip arthroplasty were analyzed. Based on the results of the regression analysis, a preoperative evaluation model was established. The ROC curve and the Hosmer-Lemeshow test were used to evaluate the model prediction performance. Results Multivariate analysis showed age (OR=1.239, 95%CI: 1.002-1.531, P=0.048), Glu (OR=2.961, 95%CI: 1.055-8.311, P=0.039), surgical size (OR=4.997, 95%CI: 1.269-19.686, P=0.021) were risk factors for postoperative complications, Albumin (OR=0.696, 95%CI: 0.535-0.904, P=0.007) was a protective factor for postoperative complications (P<0.05). The ROC curve showed a nomogram model predicting the area under the complication curve (AUC) of 0.988 (95%CI:0.975-1.000), with a specificity of 96.77% and a sensitivity of 99.82%. Conclusion A nomogram model based on age, Glu, albumin, surgery size to predict the risk of complications after hip arthroplasty in elderly patients has a good specificity and sensitivity, high clinical value. Key words: Aged; Arthroplasty, replacement, hip; Postoperative complications; Risk factor; Nomogram model

Comparison of the effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty.

Effect and clinical value in general anesthesia and combined spinal-epidural anesthesia in elderly patients undergoing hip arthroplasty were compared. One hundred and six patients with hip arthroplasty in the Affiliated Nanhua Hospital, University of South China from May 2013 to July 2015 were selected as the research subjects, including 50 patients in the study group who received combined spinal-epidural anesthesia by ondansetron hydrochloride tablets combined with spinal-epidural puncture kit, and 56 patients in the control group who received general anesthesia by fast-induced endotracheal intubation. Retrospective analysis was performed in terms of anesthesia effect, complete block time, anesthesia onset time, hemodynamic parameters at different time points before and after the surgery, and adverse reactions after the surgery. The study group had a statistically shorter onset time and a statistically shorter complete block time than the control group (P<0.05). No significant difference in the heart rate, systolic blood pressure or diastolic blood pressure before the surgery in the two groups was shown (P>0.05); the heart rate, systolic blood pressure, and diastolic blood pressure in the study group 20 min after the start of the operation and 15 min before the end of the operation were significantly higher those in the control group (P<0.05); the adverse reactions such as venous thrombosis, pulmonary infection, and nausea and vomiting in the study group were fewer than those in the control group (P<0.05). For elderly patients with fracture surgery, both the general anesthesia and the combined spinal-epidural anesthesia can maintain a good anesthesia effect, but the combined spinal-epidural anesthesia can shorten the onset time and has less impact on the patient's hemodynamic parameters and less incidence of complications, thus worthy of clinical promotion.

Intraoperative Sedation With Dexmedetomidine is Superior to Propofol for Elderly Patients Undergoing Hip Arthroplasty

Peripheral nerve block is a preferable method for elderly patients receiving hip arthroplasty. Sedation with dexmedetomidine may reduce postoperative delirium (POD). The aim of this study was to investigate whether intraoperative sedation with dexmedetomidine, as a supplementary to peripheral nerve block for elderly patients receiving total hip arthroplasty, can decrease the prevalence of POD. A prospective, randomized controlled study was conducted with patients 65 years of age or older who underwent total hip arthroplasty between June 2016 and June 2017. The patients were randomly assigned to receive a lumbosacral plexus plus T12 paravertebral block supplemented with propofol or dexmedetomidine for sedation. Incidence of POD was the primary endpoint and was determined with the confusion assessment method, and incidence of postoperative cognitive dysfunction (POCD) was assessed with the mini-mental state examination. The time of ambulation, discharge time, and complications over a 30-day postsurgery period were also recorded. A total of 296 patients were randomly assigned to 2 groups. The patients sedated with dexmedetomidine had lower incidences of POD and POCD and were out of bed and discharged sooner than the patients sedated with propofol. There was no difference in complications between the 2 groups. As a supplementary to peripheral nerve block, intraoperative sedation with dexmedetomidine could be associated with a lower incidence of POD, which may have benefits on reducing the incidence of early POCD and offering a better short-term recovery for elderly patients receiving hip arthroplasty.

Continuous lumbar plexus block reduces the incidence of early postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty

To observe the impacts of continuous lumbar plexus block (CLPB) on postoperative cognitive dysfunction (POCD) in elderly patients undergoing hip arthroplasty. Methods: Sixty elderly patients scheduled for hip arthroplasty with general anesthesia, were randomly allocated into a CLPB group and a PCIA group (n=30 each). In the CLPB group, lumbar plexus block was performed before trachea intubation, and CLPB was used for postoperative analgesia. In the PCIA group, intravenous analgesia was controlled in patients after operation. Visual Analogue Scale (VAS) at 12, 24, and 48 h after operation was recorded. Mini-Mental State Examination (MMSE) scale was used to evaluate the cognitive dysfunction at the 1st day before operation (D0) and at the 1st (D1), 3rd (D3), and 7th (D7) days after operation and the occurrence of POCD was recorded. S-100β concentrations were detected by ELISA at D1, D3, and D7. Postoperative adverse events were recorded. Results: VAS scores at 12, 24, and 48 h after operation in the CLPB group were significantly lower than those in the PCIA group (P<0.05). Compared with the PCIA group, the MMSE scores were significantly higher (P<0.05), and the incidence of POCD at D1 and D3 was obviously reduced in the CLPB group (P<0.05). S-100β concentration at D1 and D3 in the CLPB group was significantly lower than that in the PCIA group (P<0.05). Conclusion: Application of CLPB in elderly patients undergoing hip arthroplasty could obviously relieve their postoperative pain, inhibit the production of S-100β, and reduce the incidence of early postoperative cognitive dysfunction.

Tranexamic acid reduces blood loss in hip arthroplasty for senile femoral neck fracture

Objective To investigate the effect of intraoperative dripping of intravenous tranexamic acid (TXA) on the perioperative blood loss in elderly patients undergoing hip arthroplasty for femoral neck fracture. Methods From January 2016 to August 2017, 118 elderly patients with femoral neck fracture were treated with hip arthroplasty at Department of Orthopaedics, China-Japan Friendship Hospital. They were 45 males and 73 females, with an average age of 77.1 years. Of them, 60 (TXA group) were subjected to intravenous TXA dripping over 10 minutes by 2 doses (15 mg/kg TXA dissolved in 100 mL of saline) with the first dose before incision and the second one at wound closure; 58 (control group) were subjected to intravenous administration of 100 mL of saline solution in a similar fashion. Blood routine tests were carried out one day before operation, and the first and third days after operation. The transfusion rate and volume, and surgical blood loss were recorded. The total blood loss on postoperative 1-day and 3-day were calculated according to hemoglobin balance method. The 2 groups were compared in terms of blood loss and complications. Results The blood transfusion rate (21.7%), blood transfusion volume (310.8±85.7 mL), surgical blood loss (424.3±87.6 mL), total blood loss on postoperative 1-day (1,284.6±288.7 mL) and total blood loss on postoperative 3-day (1,501.2±337.1 mL) in the TXA group were all significantly lower than those in the control group (41.4%, 379.8±110.2 mL, 526.7±113.8 mL, 1,534.8±279.2 mL and 1,887.4±431.8 mL, respectively) (P 0.05). Conclusion In elderly patients undergoing hip arthroplasty for femoral neck fracture, intravenous TXA administration may lower transfusion rate, reduce transfusion volume, and decrease surgical blood loss and postoperative total blood loss without increasing the risks of surgery-related complications like thrombosis. Key words: Tranexamic acid; Femoral neck fractures; Arthroplasty, replacement, hip; Postoperative hemorrhage

The Effect of Melatonin on Early Postoperative Cognitive Decline in Elderly Patients Undergoing Hip Arthroplasty

(Abstracted from J Clin Anesth, 39:77–81, 2017) Postoperative cognitive decline (POCD) is a common complication following surgery, especially in elderly patients (aged >60 years). Overall sleep loss and sleep fragmentation have been known to negatively impact cognitive performance, thus emphasizing the need to improve postoperative sleep quality to ameliorate POCD.

The effect of melatonin on early postoperative cognitive decline in elderly patients undergoing hip arthroplasty: A randomized controlled trial

Study objectiveThe purpose of the present study was to investigate whether exogenous melatonin supplementation could ameliorate early postoperative cognitive decline (POCD) in aged patients undergoing hip arthroplasty with spinal anesthesia. DesignProspective cohort study. SettingDepartment of Anesthesiology, Jinling Hospital, Nanjing University, Nanjing, China. PatientsOne hundred and thirty–nine patients with ASA I–III, older than 65yr of age (mean age: 74.5±5.5; gender: male 53 and female 86), scheduled for hip arthroplasty were included in the present study. InterventionsPatients were randomized to receive 1mg oral melatonin or placebo daily 1h before bedtime one day before surgery and for another 5 consecutive days postoperatively. MeasurementsThe subject assessment, including Mini–Mental State Examination (MMSE) score, subjective sleep quality, general well–being, postoperative fatigue, and visual analogue scale for pain were evaluated pre–operatively and at days 1, 3, 5, and 7 after surgery. Main resultsThe MMSE score in the control group decreased significantly after surgery when compared with its own preoperative value or the melatonin group at days 1, 3, and 5. However, the MMSE score in the melatonin group remained unchanged during the 7days of monitoring. In addition, significant postoperative impairments of subjective sleep quality, general well–being, and fatigue were found in the control group when compared with the melatonin group. ConclusionPeroperative melatonin supplementation might improve early POCD, suggesting restoration of normal circadian function with good sleep quality may be one of the key factors in preventing or treating POCD.

Administration of HES in elderly patients undergoing hip arthroplasty under spinal anesthesia is not associated with an increase in renal injury

BackgroundHydroxyethyl starch (HES) is applied to achieve volume expansion during surgery; however, nephrotoxicity may be induced in patients with sepsis. Simultaneously, neutrophil gelatinase-associated lipocalin (NGAL) and IL-18 have been illustrated as pivotal indicators to diagnose the acute kidney injury (AKI) early. This multi-center, randomized, double-blinded, placebo-controlled study aimed to investigate whether 6% HES 130/0.4 administration caused postoperative AKI, which can be revealed by urinary and plasma NGAL and IL-18 estimations in elderly patients with normal renal function undergoing hip arthroplasty under spinal anesthesia.Methods120 ASA I–III, patients aged >65 y undergoing hip arthroplasty under spinal anesthesia randomly received 6% HES 130/0.4 or sodium lactate Ringer’s solution 7.5 mL/kg during the first hour of surgery. 118 patients completed the study. Blood pressure, NGAL concentrations, IL18, β2 micro-albumin and albumin in urine and creatinine, NGAL and IL-18 in plasma were repeatedly measured before, during, and after surgery.ResultsThe groups were balanced in mean arterial pressure, urine and plasma NGAL, plasma IL-18 and creatinine, urine β2 microalbumin and albumin (P > 0.05). Urine IL-18 was dramatically elevated in both groups after surgery (P < 0.05), but did not vary significantly between the groups (P > 0.05).ConclusionElderly patients undergoing surgery under spinal anesthesia are a high-risk population in AKI. These patients with normal renal function receiving a spinal anesthesia for a short duration surgery would not develop AKI when 500 mL (small volume) HES is infused.Trial registrationIdentifier: NCT02361736. Registration date was 2 February 2015.