{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T20:19:27Z","timestamp":1790799567984,"version":"4.1.0"},"reference-count":50,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,3,23]],"date-time":"2023-03-23T00:00:00Z","timestamp":1679529600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>This meta-analysis aimed to determine whether peripheral nerve blocks (PNB) reduce postoperative delirium (POD) in elderly patients undergoing hip surgery. This study was registered in the International Prospective Register of Systematic Reviews (PROSPERO; CRD42022328320). The PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for randomized controlled trials (RCTs) on 26 April 2022. A total of 19 RCTs with 1977 participants were included. Perioperative PNB lowered the POD incidence on the third postoperative day (OR: 0.59, 95% CI [0.40 to 0.87], p = 0.007, I2 = 35%), in patients without underlying cognitive impairment (OR: 0.47, 95% CI [0.30 to 0.74], p = 0.001, I2 = 30%), and when a fascia iliaca compartment block (OR: 0.58, 95% CI [0.37 to 0.91], p = 0.02, I2 = 0%) or a femoral nerve block (OR: 0.33, 95% CI [0.11 to 0.99], p = 0.05, I2 = 66%) were performed. The pain score was also reduced (SMD: \u22120.83, 95% CI [\u22121.36 to \u22120.30], p = 0.002, I2 = 95%) after PNB. Perioperative PNB can lower the POD incidence and pain scores up to the third postoperative day. However, considering the wide variety of PNBs performed, more trials are needed to identify the effects of each PNB on POD.<\/jats:p>","DOI":"10.3390\/jcm12072459","type":"journal-article","created":{"date-parts":[[2023,3,24]],"date-time":"2023-03-24T02:34:54Z","timestamp":1679625294000},"page":"2459","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["The Effect of Peripheral Nerve Block on Postoperative Delirium in Older Adults Undergoing Hip Surgery: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6167-4952","authenticated-orcid":false,"given":"Su Yeon","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Young","family":"Jo","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hyo-Seok","family":"Na","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sung-Hee","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sang-Hwan","family":"Do","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0991-7061","authenticated-orcid":false,"given":"Hyun-Jung","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam 13620, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,3,23]]},"reference":[{"key":"ref_1","unstructured":"Association, A.P. (2023, January 03). DSM-5. Available online: https:\/\/www.psychiatry.org\/psychiatrists\/practice\/dsm."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"75","DOI":"10.1016\/j.bjae.2020.10.004","article-title":"Postoperative cognitive dysfunction in clinical practice","volume":"21","author":"Brodier","year":"2021","journal-title":"BJA Educ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12913-018-3345-x","article-title":"A hospital-wide evaluation of delirium prevalence and outcomes in acute care patients-a cohort study","volume":"18","author":"Schubert","year":"2018","journal-title":"BMC Health Serv. Res."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-020-1449-8","article-title":"Incidence of and risk factors for postoperative delirium in older adult patients undergoing noncardiac surgery: A prospective study","volume":"20","author":"Iamaroon","year":"2020","journal-title":"BMC Geriatr."},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Park, E.A., and Kim, M.Y. (2019). Postoperative Delirium is Associated with Negative Outcomes and Long-Term Mortality in Elderly Koreans: A Retrospective Observational Study. Medicina, 55.","DOI":"10.3390\/medicina55100618"},{"key":"ref_6","unstructured":"Chen, F. (2022). Postoperative Delirium in Orthopedic Surgery: Etiology and Risk Factors. J. Evol. Med., 10."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"4","DOI":"10.4097\/kja.d.18.00073.1","article-title":"Postoperative delirium","volume":"72","author":"Oh","year":"2019","journal-title":"Korean J. Anesthesiol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1186\/s13019-021-01496-w","article-title":"Risk factors of postoperative delirium after cardiac surgery: A meta-analysis","volume":"16","author":"Chen","year":"2021","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e32420","DOI":"10.1002\/brb3.2420","article-title":"Identification of risk factors for postoperative delirium in elderly patients with hip fractures by a risk stratification index model: A retrospective study","volume":"11","author":"Wang","year":"2021","journal-title":"Brain Behav."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"106063","DOI":"10.1016\/j.ijsu.2021.106063","article-title":"Risk factors for postoperative delirium: An umbrella review of systematic reviews","volume":"93","author":"Bramley","year":"2021","journal-title":"Int. J. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12888-020-02742-6","article-title":"Incidence and risk factors associated with postoperative delirium following primary elective total hip arthroplasty: A retrospective nationwide inpatient sample database study","volume":"20","author":"Yang","year":"2020","journal-title":"BMC Psychiatry"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1093\/pm\/pnaa314","article-title":"Preoperative Acute Pain Is Associated with Postoperative Delirium","volume":"22","author":"Ding","year":"2020","journal-title":"Pain Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"616","DOI":"10.1097\/ACO.0000000000001048","article-title":"Role of regional anesthesia in Enhanced Recovery After Surgery (ERAS) protocols","volume":"34","author":"Mancel","year":"2021","journal-title":"Curr. Opin. Anesthesiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s13018-020-02127-1","article-title":"Risk factors of postoperative delirium in the knee and hip replacement patients: A systematic review and meta-analysis","volume":"16","author":"Rong","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_15","first-page":"CD001159","article-title":"Peripheral nerve blocks for hip fractures in adults","volume":"11","author":"Guay","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_16","first-page":"16484","article-title":"Efficacy and safety of ultrasound-guided fascia iliaca compartment block using dexmedetomidine combined with ropivacaine in aged patients undergoing hip replacement","volume":"10","author":"Hua","year":"2017","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1265","DOI":"10.1007\/s12630-019-01428-2","article-title":"Continuous fascia iliaca block for acute hip fractures: A randomized-controlled pilot study","volume":"66","author":"Loessin","year":"2019","journal-title":"Can. J. Anesth. J. Can. D\u2019anesth\u00e9sie"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"127","DOI":"10.1007\/s10195-009-0062-6","article-title":"Fascia iliaca block prophylaxis for hip fracture patients at risk for delirium: A randomized placebo-controlled study","volume":"10","author":"Mouzopoulos","year":"2009","journal-title":"J. Orthop. Traumatol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1155\/2015\/872651","article-title":"Effects of continuous fascia iliaca compartment blocks for postoperative analgesia in patients with hip fracture","volume":"20","author":"Nie","year":"2015","journal-title":"Pain Res. Manag."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 statement: An updated guideline for reporting systematic reviews","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1111\/jebm.12266","article-title":"Gray literature: An important resource in systematic reviews","volume":"10","author":"Paez","year":"2017","journal-title":"J. Evid.-Based Med."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Wan, X., Wang, W., Liu, J., and Tong, T. (2014). Estimating the sample mean and standard deviation from the sample size, median, range and\/or interquartile range. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-135"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"71","DOI":"10.4103\/2542-4157.207014","article-title":"Effects of lumbar plexus-sciatic nerve block combined with sevoflurane on cognitive function in elderly patients after hip arthroplasty: Study protocol for a prospective, single-center, open-label, randomized, controlled clinical trial","volume":"2","author":"Guo","year":"2017","journal-title":"Clin. Trials Orthop. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/j.annfar.2009.12.021","article-title":"Influence of the fascia iliaca compartment block on postoperative cognitive status in the elderly","volume":"33","author":"Perrier","year":"2010","journal-title":"Ann. Fr. D\u2019anesthesie Reanim."},{"key":"ref_25","first-page":"634","article-title":"The effect of the fascia iliaca compartment block combined with laryngeal mask general anesthesia on the internal fixation of senile femoral neck fracture","volume":"13","author":"Xu","year":"2020","journal-title":"Int. J. Clin. Exp. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A revised tool for assessing risk of bias in randomised trials","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.1136\/bmj.39500.677199.AE","article-title":"Grading quality of evidence and strength of recommendations for diagnostic tests and strategies","volume":"336","author":"Oxman","year":"2008","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"901","DOI":"10.15537\/smj.2019.9.24483","article-title":"Pre-emptive analgesia with continuous fascia iliaca compartment block reduces postoperative delirium in elderly patients with hip fracture. A randomized controlled trial","volume":"40","author":"Hao","year":"2019","journal-title":"Saudi Med. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12877-019-1266-0","article-title":"Fascia iliaca compartment block as a preoperative analgesic in elderly patients with hip fractures\u2013effects on cognition","volume":"19","author":"Wennberg","year":"2019","journal-title":"BMC Geriatr."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1689","DOI":"10.1016\/j.injury.2019.03.008","article-title":"Comparison of the postoperative analgesic efficacies of intravenous acetaminophen and fascia iliaca compartment block in hip fracture surgery: A randomised controlled trial","volume":"50","author":"Yamamoto","year":"2019","journal-title":"Injury"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1111\/jgs.14386","article-title":"Regional Nerve Blocks Improve Pain and Functional Outcomes in Hip Fracture: A Randomized Controlled Trial","volume":"64","author":"Morrison","year":"2016","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"e019650","DOI":"10.1136\/bmjopen-2017-019650","article-title":"Femoral nerve block intervention in neck of femur fracture (FINOF): A randomised controlled trial","volume":"8","author":"Rowlands","year":"2018","journal-title":"BMJ Open"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1634","DOI":"10.1016\/j.injury.2020.04.013","article-title":"Complications with focus on delirium during hospital stay related to femoral nerve block compared to conventional pain management among patients with hip fracture\u2014A randomised controlled trial","volume":"51","author":"Unneby","year":"2020","journal-title":"Injury"},{"key":"ref_34","first-page":"109","article-title":"The effects of early femoral nerve block intervention on preoperative pain management and incidence of postoperative delirium geriatric patients undergoing trochanteric femur fracture surgery: A randomized controlled trial","volume":"26","author":"Uysal","year":"2020","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_35","first-page":"2104","article-title":"Femoral nerve block as pain relief in hip fracture. A good alternative in perioperative treatment proved by a prospective study","volume":"101","author":"Kullenberg","year":"2004","journal-title":"Lakartidningen"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1097\/AJP.0000000000000502","article-title":"Peripheral Nerve Block as a Supplement to Light or Deep General Anesthesia in Elderly Patients Receiving Total Hip Arthroplasty: A Prospective Randomized Study","volume":"33","author":"Mei","year":"2017","journal-title":"Clin. J. Pain"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"6685497","DOI":"10.1155\/2021\/6685497","article-title":"Comparison of effects between combined lumbar-sacral plexus block plus general anesthesia and unilateral spinal anesthesia in elderly patients undergoing hip fracture surgery: A pilot randomized controlled trial","volume":"2021","author":"Tang","year":"2021","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_38","first-page":"858","article-title":"Continuous lumbar plexus block reduces the incidence of early postoperative cognitive dysfunction in elderly patients undergoing hip arthroplasty","volume":"43","author":"Li","year":"2018","journal-title":"Zhong Nan Da Xue Xue Bao. Yi Xue Ban. Cent. South Univ. Med. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Bielka, K., Kuchyn, I., Tokar, I., Artemenko, V., and Kashchii, U. (2021). Psoas compartment block efficacy and safety for perioperative analgesia in the elderly with proximal femur fractures: A randomized controlled study. BMC Anesth., 21.","DOI":"10.1186\/s12871-021-01473-9"},{"key":"ref_40","first-page":"A47","article-title":"Proximal femur fracture anesthesia thechnique\u2014Does it really matter?","volume":"70","author":"Carvalho","year":"2021","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"9787879","DOI":"10.1155\/2021\/9787879","article-title":"Safety of Different Anesthesia Methods Combined with Intravenous Fast Channel Anesthesia in Lower Extremity Orthopedic Surgery of the Elderly","volume":"2021","author":"Chen","year":"2021","journal-title":"Evid.-Based Complement. Altern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"881","DOI":"10.1097\/AJP.0000000000000988","article-title":"Ultrasound-guided Multiple Nerve Blocks: A Safe and Effective Anesthetic Modality in Geriatric Hip Fracture Patients","volume":"37","author":"Gu","year":"2021","journal-title":"Clin. J. Pain"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"e16157","DOI":"10.1097\/MD.0000000000016157","article-title":"The efficacy of fascia iliaca compartment block for pain control after hip fracture: A meta-analysis","volume":"98","author":"Hong","year":"2019","journal-title":"Medicine"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"245","DOI":"10.1017\/cem.2015.94","article-title":"Use of femoral nerve blocks to manage hip fracture pain among older adults in the emergency department: A systematic review","volume":"18","author":"Riddell","year":"2016","journal-title":"Can. J. Emerg. Med."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"548","DOI":"10.1002\/ca.22348","article-title":"Hilton\u2019s law revisited","volume":"27","author":"Carmichael","year":"2014","journal-title":"Clin. Anat."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"1149","DOI":"10.1093\/pm\/pnab061","article-title":"Sensory Innervation of the Hip Joint and Referred Pain: A Systematic Review of the Literature","volume":"22","author":"Laumonerie","year":"2021","journal-title":"Pain Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"103151","DOI":"10.1016\/j.otsr.2021.103151","article-title":"The effect of regional nerve block on perioperative delirium in hip fracture surgery for the elderly: A systematic review and meta-analysis of randomized controlled trials","volume":"108","author":"Kim","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"937293","DOI":"10.3389\/fsurg.2022.937293","article-title":"Effect of regional anesthesia on the postoperative delirium: A systematic review and meta-analysis of randomized controlled trials","volume":"9","author":"Li","year":"2022","journal-title":"Front. Surg."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1097\/AAP.0b013e3182580fd0","article-title":"Randomized study of the effect of local anesthetic volume and concentration on the duration of peripheral nerve blockade","volume":"37","author":"Fredrickson","year":"2012","journal-title":"Reg. Anesth. Pain Med."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1097\/PRS.0000000000005989","article-title":"Local anesthetic systemic toxicity: A narrative literature review and clinical update on prevention, diagnosis, and management","volume":"144","author":"Gitman","year":"2019","journal-title":"Plast. Reconstr. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/7\/2459\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T19:01:37Z","timestamp":1760122897000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/7\/2459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,23]]},"references-count":50,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,4]]}},"alternative-id":["jcm12072459"],"URL":"https:\/\/doi.org\/10.3390\/jcm12072459","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,23]]}}}