Objective To investigate the influence of ultrasound-guided different approaches of fascia iliaca compartment block (FICB) on postoperative delirium and early rehabilitation quality in elderly patients undergoing hip replacement. Methods The clinical data of 120 elderly patients with femoral neck fractures who underwent total hip replacement in the hospital from May 2024 to May 2025 were retrospectively analyzed. All patients underwent ultrasound-guided FICB. According to the different approaches, they were divided into group A (56 cases, subinguinal approach) and group B (64 cases, suprainguinal approach). The nerve block related conditions, pain status[visual analogue scale (VAS) ], occurrence of postoperative delirium, early rehabilitation quality[40-item quality of recovery scale (QoR-40) ]and occurrence of complications were compared between the two groups. Results There were no statistical differences in the operation time of nerve block and onset time of femoral nerve block between the two groups (P>0.05). The onset time of lateral femoral cutaneous nerve block in group B was shorter than that in group A (P<0.05). Compared with admission, the VAS scores in the two groups at 12 h and 24 h after surgery were decreased (P<0.05). Compared with 12 h after surgery, the VAS scores in the two groups at 24 h after surgery were increased, but the VAS scores in group B at 12 h and 24 h after surgery were lower than those in group A (P<0.05). The total incidence rate of postoperative delirium in group B was lower than that in group A (P<0.05). Compared with 1 d after surgery, the QoR-40 scores in the two groups at 2 d after surgery were increased, and the QoR-40 scores in group B at 1 d and 2 d after surgery were higher than those in group A (P<0.05). The postoperative first ambulation time in group B was shorter than that in group A (P<0.05). There were no statistical differences in the complications between the two groups (P>0.05). Conclusion Compared with the subinguinal approach, ultrasound-guided suprainguinal FICB in elderly patients undergoing total hip arthroplasty achieved faster onset of lateral femoral cutaneous nerve blockade, improved postoperative analgesia, reduced the incidence of postoperative delirium, and facilitated early rehabilitation, without increasing the risk of complications.
Key words
total hip replacement /
fascia iliaca compartment block /
elderly /
ultrasound /
surgical approach /
delirium /
rehabilitation quality
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