Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.116844
Revised: January 12, 2026
Accepted: February 6, 2026
Published online: May 18, 2026
Processing time: 177 Days and 23 Hours
Neuroinflammation and circadian rhythm disruption caused by pain are the primary causes of postoperative cognitive dysfunction. We hypothesize that the administration of liposomal bupivacaine (LB) for fascia iliaca compartment block (FICB) can alleviate pain intensity in patients with femoral neck fractures and reduce the incidence of postoperative cognitive dysfunction.
To explore the efficacy of LB for postoperative analgesia through FICB and their role in reducing cognitive dysfunction.
Eighty patients aged ≥ 65 years with femoral neck fractures were enrolled and randomly divided into the LB group and the control group according to different analgesic methods. The LB group received 0.266% LB solution via ultrasound-guided supra-inguinal FICB 1 day before surgery, while the control group did not receive FICB. Both groups were connected to a patient-controlled intravenous analgesia pump for postoperative analgesia. Comparisons were made between the two groups regarding resting and exercise visual analog scale (VAS) scores at 12 hours, 24 hours, and 48 hours after surgery, the dosage of sufentanil in the analgesia pump, the mini-mental state examination (MMSE) scores 1 day before surgery and 1 day, 3 days, and 7 days after surgery, the Pittsburgh Sleep Quality Index (PSQI) scores, postoperative blood glucose and serum cortisol levels, and related adverse reactions.
The mean arterial pressure was lower upon entering the operating room (T1) (P = 0.009) and 12 hours after surgery (T3) (P = 0.037) in the LB group than in the control group. The hazard ratio (HR) was lower at T1 (P = 0.000) and T3 (P = 0.000) in the LB group than in the control group. The blood glucose at T1 (P = 0.008), 6 hours after surgery (P = 0.000), T3 (P = 0.009), and 48 hours after surgery (T5) (P = 0.000) were lower in the LB group than in the control group. The serum cortisol levels at T1 (P = 0.028) and T3 (P = 0.14) were lower in the LB group than in the control group. The resting and exercise VAS scores at T1 (P = 0.000), T3 (P = 0.002), 1 day after surgery (P = 0.000) and T5 (P = 0.000) were lower in the LB group than in the control group. The sufentanil dose was significantly lower in the LB group than in the control group (P = 0.004). The MMSE scores at T1 (P = 0.000), 3 days after surgery (P = 0.000), 7 days after surgery (P = 0.000) were lower in the control group than in the LB group. The PSQI scores were lower in the LB group than in the control group (P = 0.000). The incidences of postoperative nausea and vomiting (P = 0.041) and excessive sleepiness (P = 0.01) were significantly lower in the LB group than in the control group.
FICB with liposomal bupivacaine can provide continuous analgesia for patients undergoing femoral neck fracture surgery, significantly alleviating pain and anxiety, improving sleep quality, reducing opioid consumption, lowering the incidence of nausea and vomiting, and accelerating postoperative recovery.
Core Tip: This study employed an innovative approach by utilizing a bupivacaine liposome solution for preoperative iliofascial block in patients with femoral neck fractures. By assessing cognitive function scores, plasma cortisol levels, sleep quality evaluation scales, and resting and exercise visual analog scale scores, we found that patients receiving this anesthetic technique experienced enhanced postoperative recovery quality. Consequently, this approach also mitigated the severity of postoperative cognitive dysfunction.