Effect of liposomal bupivacaine for iliac fascia block on postoperative cognitive dysfunction in patients with femoral neck fractures

doi:10.5312/wjo.v17.i5.116844

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World Journal of Orthopedics

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2218-5836

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Randomized Controlled Trial

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Orthop. May 18, 2026; 17(5): 116844
Published online May 18, 2026. doi: 10.5312/wjo.v17.i5.116844

Table 1 Comparison of general data between the two patient groups, n (%)/mean ± SD

Group	Year	BMI (kg/m²)	ASA
Group	Year	BMI (kg/m²)	I	II	III
Control (n = 40)	61.0 ± 7.0	21.8 ± 2.4	5 (12.5)	15 (37.5)	20 (50.0)
LB (n = 40)	60.0 ± 6.5	21.7 ± 2.5	4 (10.0)	11 (27.5)	25 (62.5)
t/χ² value	0.741	0.073	1.318
P value	0.461	0.942	0.529

BMI: Body mass index; LB: Liposomal bupivacaine; ASA: American Society of Anesthesiologists.

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Table 2 Comparison of mean arterial pressure and heart rate at each time point between the two patient groups, median (25^th-75^th percentiles)

	Group	T0	T1	T2	T3
MAP (mmHg)	Control (n = 40)	116.0 (103.0-126.0)	102.0 (88.0-113.0)	91.0 (76.0-101.0)	101.0 (93.0-112.0)
MAP (mmHg)	LB (n = 40)	110.0 (92.0-127.0)	92.0 (87.0-96.0)^a	91.0 (80.0-101.0)	99.0 (90.0-100.0)^a
z value		-1.261	-2.628	-0.284	-2.082
P value		0.207	0.009	0.776	0.037
Heart rate	Control (n = 40)	90.0 (79.0-108.0)	87.0 (76.0-87.0)	78.0 (71.0-85.0)	85.0 (78.0-92.0)
Heart rate	LB (n = 40)	85.0 (79.0-94.0)	73 (70.0-76.0)^a	76.0 (70.0-83.0)	74 (66.0-80.0)^a
z value		-1.136	-4.797	-0.809	-5.109
P value		0.256	0.000	0.419	0.000

^aP < 0.05.

LB: Liposomal bupivacaine; MAP: Mean arterial pressure; T0: 1 day before surgery; T1: Upon entering the operating room; T2: 6 hours after surgery; T3: 12 hours after surgery.

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Table 3 Comparison of blood glucose and serum cortisol levels at each time point between the two patient groups, median (25^th-75^th percentiles)

Indicator	Group	T0	T1	T2	T3
Blood glucose (mmol/L)	Control (n = 40)	5.18 (4.48-6.06)	4.84 (4.14-5.67)	6.58 (6.38-6.79)	8.85 (7.35-10.15)
Blood glucose (mmol/L)	LB (n = 40)	5.12 (4.48-5.78)	4.18 (3.13-5.19)^a	5.12 (4.34-6.29)^a	7.91 (6.61-8.11)^a
z value		-0.380	-2.656	-4.850	-2.622
P value		0.704	0.008	0.000	0.009
Serum cortisol (mmol/L)	Control (n = 40)	86.56 (63.37-110.64)	120.55 (102.65-140.87)		131.65 (113.65-151.87)
Serum cortisol (mmol/L)	LB (n = 40)	88.54 (70.65-108.87)	20.0 (15.0-27.0)^a		126.39 (108.65-142.68)^a
t value		-0.318	-2.204		-1.477
P value		0.751	0.028		0.140

^aP < 0.05.

LB: Liposomal bupivacaine; T0: 1 day before surgery; T1: Upon entering the operating room; T2: 6 hours after surgery; T3: 12 hours after surgery.

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Table 4 Comparison of visual analog scale scores for resting pain and exercise pain at each time point between the two patient groups, median (25^th-75^th percentiles)

Indicator	Group	T0	T1	T3	T4	T5
Rest VAS score	Control (n = 40)	6.0 (5.0-6.0)	6.0 (5.0-6.0)	2.0 (2.0-3.0)	4.0 (3.0-4.0)	4.0 (4.0-5.0)
Rest VAS score	LB (n = 40)	6.0 (5.0-6.0)	3.0 (2.0-4.0)^a	2.0 (1.0-2.0)^a	2.0 (2.0-3.0)^a	3.0 (3.0-4.0)^a
z value		-0.045	-3.771	-3.053	-4.340	-3.748
P value		0.964	0.000	0.002	0.000	0.000
Exercise VAS score	Control (n = 40)	8.0 (8.0-9.0)	8.0 (6.00-8.00)	3.0 (3.00-4.00)	4.0 (4.00-5.00)	4.0 (4.0-5.0)
Exercise VAS score	LB (n = 40)	9.0 (8.0-9.0)	4.0 (3.00-4.00)^a	2.00 (2.00-3.00)^a	3.0 (2.00-4.00)^a	4.0 (3.0-4.0)^a
z value		-0.783	-2.962	-3.968	-4.547	-3.092
P value		0.433	0.003	0.000	0.000	0.002

^aP < 0.05.

Visual analogue scale score ranges from 0 to 10, 0 = no pain, 10 = worst pain. LB: Liposomal bupivacaine; VAS: Visual analogue scale; T0: One day before surgery; T1: Upon entering the operating room; T2: 6 hours after surgery; T3: 12 hours after surgery; T4: 24 hours after surgery; T5: 48 hours after surgery.

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Table 5 Comparison of mini-mental state examination scores of the two patient groups at each time point, median (25^th-75^th percentiles)

Indicator	Group	T0	T1	T6	T7
MMSE (score)	Control (n = 40)	27.0 (26.0-28.0)	27.0 (26.0-28.0)	24.0 (23.0-25.0)	25.0 (24.0-25.0)
MMSE (score)	LB (n = 40)	27.0 (26.0-28.0)	28.0 (28.0-28.0)^a	27.0 (26.0-280)^a	27.0 (27.0-28.0)^a
t value		-2.567	-3.624	-6.275	-5.662
P value		0.631	0.000	0.000	0.000

^aP < 0.05.

Mini-mental state examination score ranges from 0 to 30. LB: Liposomal bupivacaine; MMSE: Mini-mental state examination; T0: 1 day before surgery; T1: Upon entering the operating room; T6: 3 days after surgery; T7: 7 days after surgery.

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Table 6 Comparison of insomnia scale (Pittsburgh Sleep Quality Index) between the two patient groups, median (25^th-75^th percentiles)

Indicator	Group	Sleep quality	Bed time	Sleep duration	Sleep efficiency	Sleep disorder	Hypnotic drugs	Daytime dysfunction	Total score
PSQI	Control (n = 40)	2 (2-3)	3 (2-3)	2 (2-3)	2 (2-3)	3 (2-3)	2 (2-3)	2 (2-3)	17 (16-18)
PSQI	LB (n = 40)	2 (2-3)	2 (2-3)	2 (1-3)^a	2 (2-3)	2 (1-3)^a	2 (2-2)^a	2 (2-2)^a	14 (13-16)^a
z value		-1.153	-1.045	-2.010	-0.437	-2.021	-4.117	-4.189	-4.608
P value		0.249	0.296	0.044	0.662	0.043	0.000	0.000	0.000

^aP < 0.05.

Total score: 21 points, > 5 points indicates poor sleep quality. LB: Liposomal bupivacaine; PSQI: Pittsburgh Sleep Quality Index.

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Table 7 Comparison of adverse reactions and remedial indicators between the two patient groups, median (25^th-75^th percentiles), n (%)

Group	Remedial indicator		Adverse reactions
Group	Sufentanil dose	Number of compressions	PONV	Shivering	Excessive sleepiness
Control (n = 40)	81.0 (70.0-91.0)	11.0 (8.0-16.0)	15 (37.5)	7 (17.5)	16 (40.0)
LB (n = 40)	68.0 (66.0-78.0)^a	8.0 (5.0-9.0)^a	6 (15.0)	3 (7.5)	3 (7.5)
z/χ² value	-2.855	-3.393	5.230	1.829	11.665
P value	0.004	0.001	0.041	0.311	0.001

^aP < 0.05.

LB: Liposomal bupivacaine; PONV: Postoperative nausea and vomiting.

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Citation: Liu H, Jia T, Shuai SC, Zhao JB. Effect of liposomal bupivacaine for iliac fascia block on postoperative cognitive dysfunction in patients with femoral neck fractures. World J Orthop 2026; 17(5): 116844
URL: https://www.wjgnet.com/2218-5836/full/v17/i5/116844.htm
DOI: https://dx.doi.org/10.5312/wjo.v17.i5.116844

Liu H, Jia T, Shuai SC, Zhao JB. Effect of liposomal bupivacaine for iliac fascia block on postoperative cognitive dysfunction in patients with femoral neck fractures. World J Orthop 2026; 17(5): 116844 [DOI: 10.5312/wjo.v17.i5.116844]

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