Reducing Post-Op Cognitive Impairment in Elderly Patients with Hip Replacement

Published on December 5, 2022

Imagine you’re planning a cross-country road trip with your grandparents, who are in their golden years. You want to make sure they enjoy the journey without any hiccups, so you decide to use state-of-the-art navigation technology combined with an experienced guide to ensure a smooth ride. Similarly, in this study, researchers aimed to improve the post-operative experience for elderly patients undergoing hip replacement surgery, which can be quite challenging for them. By combining ultrasound-guided fascia iliaca compartment block (FICB) with hypobaric spinal anesthesia, they were able to significantly reduce post-operative pain and cognitive impairment compared to traditional spinal anesthesia alone. This innovative approach is like having a trusty GPS system (FICB) guiding the surgeon’s skilled hands (hypobaric spinal anesthesia), resulting in improved outcomes for the patients. The researchers believe that by managing pain levels and regulating the concentrations of certain proteins in the blood, such as β-amyloid (Aβ) and tau, they can provide a smoother recovery process and prevent early post-operative cognitive impairment.

Now, it’s worth mentioning that this study was conducted on high-risk elderly patients with hip replacement surgery, so further research is needed to determine if the same benefits can be observed in other patient populations or surgical procedures. Nonetheless, the findings of this study offer a glimmer of hope for elderly individuals undergoing hip replacement surgery. If you’re curious to learn more about this fascinating research and its potential implications, check out the link below!

ObjectiveIn this study, we aimed to observe the effects of ultrasound-guided fascia iliaca compartment block (FICB) combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.MethodsA total of 84 elderly patients—aged 65–85 years, with American Society of Anesthesiologists physical status III–IV, and scheduled for hip arthroplasty between September 2021 and May 2022—were selected. One or more organs with moderate to severe impairment were included in all patients. The patients were randomly divided into a hypobaric spinal anesthesia group (group C, control group) and an ultrasound-guided FICB combined with hypobaric spinal anesthesia group (group E, experimental group). Group C was given 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia, and group E received ultrasound-guided FICB combined with 3.5 mL of 0.32% ropivacaine hypobaric spinal anesthesia. The patients were compared using the visual analog scale (VAS) for pain, Harris hip function score, and simple Mini-Mental State Examination (MMSE) scale. Blood β-amyloid (Aβ) and neuronal microtubule-associated protein (tau) levels were measured. We compared intraoperative conditions and post-operative complications between the two groups to assess the effects of FICB combined with hypobaric spinal anesthesia on post-operative pain and cognitive function in elderly patients with high-risk hip replacement.ResultsAt 1 and 3 days after the operation, patients in group C had significantly higher VAS and lower MMES scores than those in group E. The differences were statistically significant at 1 (P < 0.01) and 3 (P < 0.05) days after the operation. At 1 day after operation, the Harris score of patients in group C was significantly lower than that of patients in group E (P < 0.05). The Aβ and tau levels of patients in group C were significantly higher than those of patients in group E at 1 day after the operation (P < 0.01). The Aβ levels of patients in group C were significantly higher than those of patients in group E at 3 days after the operation (P < 0.05). The intraoperative conditions and post-operative complication rates did not differ significantly between the two groups. At 1 day before and 5 days after the operation, there was no difference in any of the indicators.ConclusionBy lowering pain and managing Aβ and tau protein concentrations, FICB can successfully lower the incidence of early post-operative cognitive impairment in elderly patients with high-risk hip replacement.Clinical trial registrationwww.chictr.org.cn, identifier: ChiCTR2100051162.

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