Guoqiang Xu,1 Yuqing Deng,2 Hua Gao,1 Baojun Wang,1 Gang Wang,1 Ji Ma1 

1Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Thoracic Surgery, Ditan Hospital, Capital Medical University, Beijing, People’s Republic of China

Correspondence: Hua Gao, Email gaohua@ccmu.edu.cn Baojun Wang, Email docbjwang@126.com

Background: Hip fractures in elderly patients represent a significant healthcare challenge, with substantial morbidity and mortality rates. This study investigated the efficacy of continuous fascia iliaca compartment block (CFICB) in perioperative management.
Methods: A retrospective analysis was conducted on elderly patients (≥ 65 years) with intertrochanteric fractures treated between January 2020 and December 2023. Eligible patients were initially divided into CFICB (n=46) and routine analgesia (RA, n=64) groups. Propensity score matching with a caliper width of 0.21 was performed, yielding 40 patients in each group for final analysis. Matching variables included age, gender, BMI, and ASA score. Primary outcomes were Visual Analog Scale pain scores, cognitive function assessed through a two-tier protocol (Montreal Cognitive Assessment [MoCA©] screening followed by confirmatory Mini-Mental State Examination-2 [MMSE-2Ⓡ] for positive screens), and functional recovery evaluated using the Harris Hip Score.
Results: The CFICB group showed significantly lower VAS scores during the early postoperative period (≤ 72h). This was most notable at 24 hours postoperatively (2.43 ± 0.72 vs 3.45 ± 0.87, P < 0.001). Postoperative cognitive dysfunction rates were significantly lower in the CFICB group. The differences were evident at 6h (10% vs 30%, P = 0.025), 24h (15% vs 35%, P = 0.039), and 72h (5% vs 20%, P = 0.043). Multivariable analysis identified CFICB as an independent protective factor against postoperative cognitive dysfunction (adjusted OR = 0.41, 95% CI: 0.26– 0.65, P < 0.001). Harris Hip Scores at one month postoperatively were significantly higher in the CFICB group (78.56 ± 8.12 vs 72.39 ± 7.65, P = 0.008). Complication rates were comparable between groups (22.5% vs 17.5%, P = 0.576).
Conclusion: CFICB effectively improves postoperative pain management, reduces cognitive dysfunction incidence, and enhances early functional recovery in elderly patients with intertrochanteric fractures, while maintaining a favorable safety profile.

Keywords: continuous fascia iliaca compartment block, intertrochanteric fracture, cognitive function, postoperative pain, hip joint function, elderly patients, regional anesthesia