Central Venous Catheters Versus Continuous Peripheral Nerve Block Catheters: A Randomized Comparison of Puncture Site Leakage in Fascia Iliaca Compartment Analgesia for Elderly Hip Fracture Patients.

PURPOSE: To compare the incidence of puncture site leakage and postoperative analgesia between single-lumen central venous catheter (CVC) and continuous peripheral nerve block (CPNB) catheter for continuous fascia iliaca compartment block analgesia in elderly patients with hip fractures.

DESIGN

A prospective, randomized, parallel-group controlled trial.

METHODS

Sixty-four elderly participants (aged 60-75 years, American Society of Anesthesiologists class I-III) scheduled for intramedullary nail internal fixation (PFNA) of femoral intertrochanteric fractures were randomly allocated to two groups: CVC group and Continuous Peripheral Nerver Block catheter (CPNB group). In all patients, the continuous block catheter was inserted into the fascia iliaca compartment above the inguinal ligament under the guidance of ultrasound, and the postoperative analgesic pump was used. Patients in both groups underwent treatment with an ultrasound-guided in-plane approach to the fascia iliaca space via the inguinal ligament, along with the use of a postoperative analgesia pump. The degree of leakage from the two types of catheters was assessed 48 hours postoperatively, with the severity of leakage at the puncture site being qualitatively and quantitatively evaluated based on the color change of a medical-surgical film containing iodophor Secondary outcomes included the time required for puncture and catheterization, visual analog scale pain scores at 6, 24, and 48 hours postoperatively, the success rate of lower limb nerve block, and the incidence of adverse reactions to nerve block.

FINDINGS: In comparison with the CPNB group, the CVC group exhibited a significantly lower incidence of puncture site leakage (96.8% vs 16.1%, P < .001) and a smaller leakage area (19.30 ± 4.64 cm2 vs 0.61 ± 0.46 cm2, P < .001). However, no significant differences were observed in postoperative analgesic efficacy or other secondary outcomes between the two groups.

CONCLUSIONS

In elderly patients with hip fractures, using CVCs for postoperative analgesia is associated with a reduced incidence and extent of leakage at the puncture site during continuous fascia iliaca compartment block.