Background and Aims Hip fracture surgeries represent a significant burden on the healthcare system. Delirium could affect up to 61% of patients with hip fracture, and is associated with delayed recovery, higher morbidity and poor cognitive function.(1)
We hypothesize that adequate post-operative pain management using continuous supra-inguinal fascia illiaca catheter (SIFC) will reduce incidence of dementia in hip fracture patients.
Methods We evaluated a new protocol for post-operative pain management in hip fracture surgeries in a tertiary referral, Level 1 equivalent trauma centre. Upon theatre arrival, pericapsular injection 10 ml lignocaine 2% followed by threading of supra-inguinal fascia illiaca catheter (SIFC) under ultrasound guidance. Continuous bupivacaine 0.2% infusion was started postoperatively at rate of 5 ml/hr for 48 hrs.
Pain was assessed 10 min after peri-capsular injection during positioning for spinal anaesthesia (lateral position) on a scale 0–10. and every 12 hrs postoperatively for 48 hrs. Delirium was assessed upon theatre admission and every 12 hrs for 48 hrs using CAM ICU.
Results Twenty patients who had hip fracture surgery were successfully followed up, two patients were excluded because catheter was slipped in the first 24 hours.The incidence of new onset delirium was found to be 10% (2/20), there was 58% reduction in the incidence of delirium among traumatic hip fracture patients when compared to the literature (24%).(1,2) The Morphine Milligrams Equivalent (MME) in the first 24 hrs are 34±27, while in the second 24 hrs 32±25.
Conclusions Implementation of supra-inguinal fascia illiaca continuous block could reduce incidence of delirium in hip fracture population by up to 58%.
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