Fascia Iliaca Blockade in Hip Fractures: The effect on the incidence of delirium

Vries, R. de (2016) Fascia Iliaca Blockade in Hip Fractures: The effect on the incidence of delirium. thesis, Medicine.

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Abstract

Background Hip fractures mainly occur in the elderly population. This group is fragile and has a high risk for perioperative complications such as delirium, which is associated with a worse outcome. Mainly opioids are used for pain management in this population and have frequently proven to be inadequate. Recent studies stated that the use of opioids and inadequate pain management increases the risk of developing delirium. Therefore this study evaluated the effect of the fascia iliaca blockade (FICB) on admission as an alternative for the conventional pain management as a possible preventive intervention on the incidence of delirium in hip fracture patients. Materials and methods In a 2-year prospective cohort setting, from January 2014 until November 2015, two groups were defined. Patients aged 60 years and older with a hip fracture were included on admission. In the first study period conventional pain management was applied. In the second study period an ultrasound guided FICB was applied on admission. The primary outcome variable was perioperative delirium. Secondary outcomes were opioid use on the emergency room and the first pain score on the ward. All data was prospectively collected in case record forms or retrospectively gathered from the electronic patient files. Results A total of 128 patients were included during the study period. Demographics, mean ASA classification, comorbidities, anesthetic and operative procedures were comparable in both groups. However the intervention group showed a significant higher incidence of profound dementia on admission (20% vs. 4%). Delirium occurred in 29 (22.5%) of the 129 included patients. Incidence of perioperative delirium in the FICB group was 45.9% (11/24), significantly different compared to 17.5% in the usual care group (18/103). Mean opioid use and VAS-score were not statistically significantly different in both groups, but tended to be lower in the FICB group. Conclusion Patients who received an FICB showed a significant increase of delirium incidence in comparison to the control cohort. This was due to the higher presence of mental dysfunction. More data is needed to state a conclusion about the effect of FICB on the incidence of delirium. Pain and opioid use tended to be lower in favor of the FICB, although this was not found to be statistically significant.

Item Type:	Thesis (Thesis)
Supervisor name:	Wendt, dr. K.W. and Reininga, Dr. I.H.F. and El Moumni, Drs. M.
Faculty:	Medical Sciences
Date Deposited:	25 Jun 2020 10:57
Last Modified:	25 Jun 2020 10:57
URI:	https://umcg.studenttheses.ub.rug.nl/id/eprint/1761

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