title: Effect of admission fascia iliaca compartment blocks on post-operative abbreviated mental test scores in elderly fractured neck of femur patients: a retrospective cohort study.
abstract: BACKGROUND
  Post-operative cognitive impairment is common in elderly patients following surgery for hip fracture, with undertreated pain being an important etiological factor. Non-opioid based analgesic techniques, such as nerve blocks, may help reduce the risk of cognitive complications. The aim of this study was to investigate whether receiving a fascia iliaca compartment block (FICB) as part of a pre-operative analgesic regime increased the odds of high post-operative abbreviated mental test scores (AMTS) when compared with conventional analgesia without a nerve block.
  
  
  METHODS
  A retrospective data analysis of a cohort of 959 patients, aged ≥ 65 years with a diagnosis of hip fracture and admitted to a single hospital over a two-year period was performed. A standardized analgesic regime was used on all patients, and 541/959 (56.4%) of included patients received a FICB. Provision of the FICB was primarily determined by availability of an anesthetist, rather than by patient status and condition. Post-operative cognitive ordinal outcomes were defined by AMTS severity as high (score of ≥9/10), moderate, (score of 7-8) and low (score of ≤6). A multivariable ordinal logistic regression analysis was performed on patient status and clinical care factors, including admission AMTS, age, gender, source of admission, time to surgery, type of anesthesia and ASA score.
  
  
  RESULTS
  Admission FICB was associated with higher adjusted odds for a high AMTS (score of ≥9) relative to lower AMTS (score of ≤8) than conventional analgesia only (OR = 1.80, 95% CI 1.27-2.54; p = 0.001). Increasing age, lower AMTS on admission to hospital, and being admitted from a residential or nursing home were associated with worse cognitive outcomes. Mode of anesthesia or surgery did not significantly influence post-operative AMTS.
  
  
  CONCLUSIONS
  Post-operative AMTS is influenced by pre-operative analgesic regimes in elderly patients with hip fracture. Provision of a FICB to patients on arrival to hospital may improve early post-operative cognitive performance in this population.
authors.affiliation: Perioperative Medicine Fellow, University College London Hospital, London, UK. peter.odor@nhs.net.
authors.forename: Peter M
authors.initials: PM
authors.lastname: Odor
authors.affiliation: Senior Lecturer in Biostatistics, Institute of Infection and Immunity, St. George's University of London, London, UK.
authors.forename: Irina
authors.initials: I
authors.lastname: Chis Ster
authors.affiliation: Consultant, Orthogeriatrics, East Surrey Hospital, Redhill, Surrey, UK.
authors.forename: Iain
authors.initials: I
authors.lastname: Wilkinson
authors.affiliation: Consultant, Department of Anaesthesia, East Surrey Hospital, Redhill, Surrey, UK. frederic.sage@sash.nhs.uk.
authors.forename: Frederic
authors.initials: F
authors.lastname: Sage
mesh_terms: D000369:Aged, 80 and over; D000779:Anesthetics, Local / Q000494:pharmacology; D002045:Bupivacaine / Q000031:analogs & derivatives* / Q000494:pharmacology; D060825:Cognitive Dysfunction / Q000517:prevention & control*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D005267:Femoral Nerve / Q000187:drug effects; D006801:Humans; D007361:Intelligence Tests; D000077554:Levobupivacaine; D008297:Male; D009407:Nerve Block; D011183:Postoperative Complications / Q000523:psychology*; D012189:Retrospective Studies
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: Ageing: CNS changes; Fascia iliaca nerve block; Opioids and ageing; POCD: predictors