{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T09:08:28Z","timestamp":1790759308504,"version":"4.1.0"},"reference-count":34,"publisher":"PeerJ","license":[{"start":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T00:00:00Z","timestamp":1790726400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Whether early application of anterior iliopsoas muscle space block (AIMSB) impacts postoperative cognitive function remains uncertain. This study aimed to compare the incidence of postoperative delirium (POD) among patients who received AIMSB at different time points.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This prospective, single-blind, randomized trial enrolled 79 patients aged \u226565 years hospitalized for primary unilateral total hip arthroplasty (THA) due to hip fractures (December 2022 to February 2024). All patients underwent spinal anesthesia. Participants were randomized to receive AIMSB either the day before surgery (D group,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a039) or one hour before surgery (H group,\n                      <jats:italic>n<\/jats:italic>\n                      \u00a0=\u00a040). The primary outcome was the incidence of POD within 7 days. Secondary outcomes included postoperative pain scores at specified intervals, time to first rescue analgesia, cumulative opioid consumption, motor function recovery time, hospital discharge time, sleep quality, Quality of Recovery-15 (QoR-15), and laboratory tests.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Seventy-six patients completed the study per protocol. POD incidence was 8.1% (3\/37) in the day-before-surgery group and 12.8% (5\/39) in the hour-before-surgery group (risk difference, \u22124.7%; 95% CI [\u221218.4% to 9.0%];\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.71). At 6 hours postoperatively, resting pain scores (2.46 \u00b1 0.80\n                      <jats:italic>vs.<\/jats:italic>\n                      2.95 \u00b1 1.21,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.043) and movement-evoked pain scores (3.24 \u00b1 0.83\n                      <jats:italic>vs.<\/jats:italic>\n                      3.79 \u00b1 1.17,\n                      <jats:italic>P<\/jats:italic>\n                      \u00a0=\u00a00.021) were lower in the D group; however, these differences did not remain statistically significant after correction for multiple comparisons. In an exploratory\n                      <jats:italic>post-hoc<\/jats:italic>\n                      analysis, the IL-6 curve area under the curve was 0.895 (95% CI [0.784\u20130.998]) this finding requires prospective validation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among elderly patients undergoing THA for hip fracture, performing AIMSB one day preoperatively, compared to one hour preoperatively, did not significantly reduce the incidence of POD. An exploratory analysis suggested a transient early postoperative pain benefit, that did not survive multiplicity correction. These findings warrant further investigation in larger, appropriately powered trials.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.7717\/peerj.21764","type":"journal-article","created":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:48:21Z","timestamp":1790758101000},"page":"e21764","source":"Crossref","is-referenced-by-count":0,"title":["Effect of early regional anesthesia on postoperative cognitive function and the perioperative stress response in patients with hip fractures: a randomized controlled trial"],"prefix":"10.7717","volume":"14","author":[{"given":"Rui","family":"Zeng","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Jiaxing Hospital of Traditional Chinese Medicine, Jiaxing, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jingru","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zehao","family":"Wei","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Jiang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peng","family":"Ma","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Affiliated Hospital of Jiangsu University, Zhenjiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"4443","published-online":{"date-parts":[[2026,9,30]]},"reference":[{"key":"10.7717\/peerj.21764\/ref-1","doi-asserted-by":"publisher","first-page":"1141","DOI":"10.1213\/ANE.0b013e318277a270","article-title":"Preventive analgesia by local anesthetics: the reduction of postoperative pain by peripheral nerve blocks and intravenous drugs","volume":"116","author":"Barreveld","year":"2013","journal-title":"Anesthesia & Analgesia"},{"key":"10.7717\/peerj.21764\/ref-2","doi-asserted-by":"publisher","first-page":"S241","DOI":"10.1016\/j.arth.2020.02.020","article-title":"Pain control after total hip arthroplasty: a randomized controlled trial determining efficacy of fascia iliaca compartment blocks in the immediate postoperative period","volume":"35","author":"Bober","year":"2020","journal-title":"Journal of Arthroplasty"},{"key":"10.7717\/peerj.21764\/ref-3","doi-asserted-by":"publisher","first-page":"547","DOI":"10.1136\/rapm-2021-103427","article-title":"Effect of suprainguinal fascia iliaca compartment block on postoperative opioid consump- tion and functional recovery in posterolateral-approached total hip arthroplasty: a single-blind randomized controlled trial","volume":"47","author":"Carella","year":"2022","journal-title":"Regional Anesthesia & Pain Medicine"},{"key":"10.7717\/peerj.21764\/ref-4","doi-asserted-by":"publisher","first-page":"540","DOI":"10.1097\/00000542-200209000-00005","article-title":"Epidural analgesia enhances functional exercise capacity and health-related quality of life after colonic surgery: results of a randomized trial","volume":"97","author":"Carli","year":"2002","journal-title":"Anesthesiology"},{"key":"10.7717\/peerj.21764\/ref-5","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1007\/s40520-015-0359-7","article-title":"Anticholinergic drugs and negative outcomes in the older population: from biological plausibility to clinical evidence","volume":"28","author":"Collamati","year":"2016","journal-title":"Aging Clinical and Experimental Research"},{"key":"10.7717\/peerj.21764\/ref-6","doi-asserted-by":"publisher","first-page":"2405","DOI":"10.1007\/s11999-010-1357-x","article-title":"Antiemesis after total joint arthroplasty: does a single preoperative dose of aprepitant reduce nausea and vomiting?","volume":"468","author":"DiIorio","year":"2010","journal-title":"Clinical Orthopaedics and Related Research"},{"key":"10.7717\/peerj.21764\/ref-7","doi-asserted-by":"publisher","first-page":"366","DOI":"10.1097\/eja.0000000000001452","article-title":"Ultrasound-guided anterior iliopsoas muscle space block versus posterior lumbar plexus block in hip surgery in the elderly: a randomised controlled trial","volume":"38","author":"Dong","year":"2021","journal-title":"European Journal of Anaesthesiology"},{"key":"10.7717\/peerj.21764\/ref-8","doi-asserted-by":"publisher","first-page":"101122","DOI":"10.1016\/j.ijotn.2024.101122","article-title":"The effect of fascia iliaca compartment block on postoperative delirium in elder adults undergoing hip surgery: a systematic review and meta-analysis of randomized controlled trials","volume":"54","author":"Duan","year":"2024","journal-title":"International Journal of Orthopaedic and Trauma Nursing"},{"key":"10.7717\/peerj.21764\/ref-9","doi-asserted-by":"publisher","first-page":"1140","DOI":"10.1016\/s0006-3223(99)00157-2","article-title":"Role of norepinephrine in mediating stress hormone regulation of long-term memory storage: a critical involvement of the amygdala","volume":"46","author":"Ferry","year":"1999","journal-title":"Biological Psychiatry"},{"key":"10.7717\/peerj.21764\/ref-10","doi-asserted-by":"publisher","first-page":"866","DOI":"10.2106\/jbjs.19.01148","article-title":"Time to block: early regional anesthesia improves pain control in geriatric hip fractures","volume":"102","author":"Garlich","year":"2020","journal-title":"Journal of Bone and Joint Surgery"},{"key":"10.7717\/peerj.21764\/ref-11","doi-asserted-by":"publisher","first-page":"1695","DOI":"10.1213\/ane.0000000000002489","article-title":"Peripheral nerve blocks for hip fractures: a cochrane review","volume":"126","author":"Guay","year":"2018","journal-title":"Anesthesia & Analgesia"},{"key":"10.7717\/peerj.21764\/ref-12","doi-asserted-by":"publisher","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 Medical Journal"},{"key":"10.7717\/peerj.21764\/ref-13","doi-asserted-by":"publisher","first-page":"290","DOI":"10.1111\/wvn.12536","article-title":"Postoperative delirium in older patients: a systematic review of assessment and incidence of postoperative delirium","volume":"18","author":"Ho","year":"2021","journal-title":"Worldviews on Evidence-based Nursing"},{"key":"10.7717\/peerj.21764\/ref-14","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.pain.0000000000000003","article-title":"Postoperative pain treatment after total hip arthroplasty: a systematic review","volume":"156","author":"H\u00f8jer Karlsen","year":"2015","journal-title":"Pain"},{"key":"10.7717\/peerj.21764\/ref-15","doi-asserted-by":"publisher","first-page":"101282","DOI":"10.1016\/j.accpm.2023.101282","article-title":"Analgesic efficacy of anterior iliopsoas muscle space block combined with local infiltration analgesia after total hip arthroplasty: a prospective, double-blind, placebo-controlled study","volume":"42","author":"Hu","year":"2023","journal-title":"Anaesthesia Critical Care & Pain Medicine"},{"key":"10.7717\/peerj.21764\/ref-16","doi-asserted-by":"publisher","first-page":"275","DOI":"10.1186\/s12888-017-1444-6","article-title":"A randomized, double-blind, placebo-controlled trial on the role of preemptive analgesia with acetaminophen [paracetamol] in reducing headache following electroconvulsive therapy [ECT]","volume":"17","author":"Isuru","year":"2017","journal-title":"BMC Psychiatry"},{"key":"10.7717\/peerj.21764\/ref-17","doi-asserted-by":"publisher","first-page":"21514593231186722","DOI":"10.1177\/21514593231186722","article-title":"Peripheral nerve block and peri-operative neurocognitive disorders in older patients with hip fractures: a systematic review with meta-analysis","volume":"14","author":"Jia","year":"2023","journal-title":"Geriatric Orthopaedic Surgery & Rehabilitation"},{"key":"10.7717\/peerj.21764\/ref-18","doi-asserted-by":"publisher","first-page":"49","DOI":"10.1038\/nrrheum.2015.169","article-title":"TNF biology, pathogenic mechanisms and emerging therapeutic strategies","volume":"12","author":"Kalliolias","year":"2016","journal-title":"Nature Reviews Rheumatology"},{"key":"10.7717\/peerj.21764\/ref-19","doi-asserted-by":"publisher","first-page":"300","DOI":"10.1111\/joim.12586","article-title":"Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project","volume":"281","author":"Katsoulis","year":"2017","journal-title":"Journal of Internal Medicine"},{"key":"10.7717\/peerj.21764\/ref-20","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.anclin.2021.11.012","article-title":"Modifying the stress response\u2014perioperative considerations and controversies","volume":"40","author":"Kelliher","year":"2022","journal-title":"Anesthesiology Clinics of North America"},{"issue":"7","key":"10.7717\/peerj.21764\/ref-21","doi-asserted-by":"publisher","first-page":"2459","DOI":"10.3390\/jcm12072459","article-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","volume":"12","author":"Kim","year":"2023","journal-title":"Journal of Clinical Medicine"},{"key":"10.7717\/peerj.21764\/ref-22","doi-asserted-by":"publisher","first-page":"59","DOI":"10.1136\/rapm-2018-000023","article-title":"Influence of postoperative analgesia on systemic inflammatory response and postoperative cognitive dysfunction after femoral fractures surgery: a randomized controlled trial","volume":"44","author":"Kristek","year":"2019","journal-title":"Regional Anesthesia & Pain Medicine"},{"key":"10.7717\/peerj.21764\/ref-23","doi-asserted-by":"publisher","first-page":"773","DOI":"10.1016\/j.bja.2023.02.017","article-title":"Quality of recovery after pericapsular nerve group (PENG) block for primary total hip arthroplasty under spinal anaesthesia: a randomised controlled observer-blinded trial","volume":"130","author":"Kukreja","year":"2023","journal-title":"British Journal of Anaesthesia"},{"key":"10.7717\/peerj.21764\/ref-24","doi-asserted-by":"publisher","DOI":"10.21203\/rs.3.rs-5182283\/v1","article-title":"Effect of early regional anesthesia on postoperative cognitive function and the perioperative stress response in patients with hip fractures: a randomized controlled trial","author":"Ma","year":"2024"},{"key":"10.7717\/peerj.21764\/ref-25","doi-asserted-by":"publisher","first-page":"971","DOI":"10.1136\/rapm-2021-102750","article-title":"Peripheral nerve block anesthesia\/analgesia for patients undergoing primary hip and knee arthroplasty: recommendations from the International Consensus on Anesthesia-Related Outcomes after Surgery (ICAROS) group based on a systematic review and meta-analysis of current literature","volume":"46","author":"Memtsoudis","year":"2021","journal-title":"Regional Anesthesia & Pain Medicine"},{"key":"10.7717\/peerj.21764\/ref-26","doi-asserted-by":"publisher","first-page":"28","DOI":"10.1016\/j.ijsu.2011.10.001","article-title":"CONSORT 2010 explanation and elaboration: updated guidelines for reporting parallel group randomised trials","volume":"10","author":"Moher","year":"2012","journal-title":"International Journal of Surgery"},{"key":"10.7717\/peerj.21764\/ref-27","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.bbi.2018.07.016","article-title":"Oxidative stress and mitochondrial dysfunction contributes to postoperative cognitive dysfunction in elderly rats","volume":"73","author":"Netto","year":"2018","journal-title":"Brain, Behavior, and Immunity"},{"key":"10.7717\/peerj.21764\/ref-28","doi-asserted-by":"publisher","first-page":"34","DOI":"10.3928\/01477447-20230517-02","article-title":"Correlation of patient-reported preoperative narcotic use and postoperative requirements in total joint arthroplasty","volume":"47","author":"Olsen","year":"2024","journal-title":"Orthopedics"},{"key":"10.7717\/peerj.21764\/ref-29","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1093\/bja\/aev415","article-title":"Evidence of an association between brain cellular injury and cognitive decline after non-cardiac surgery","volume":"116","author":"Rappold","year":"2016","journal-title":"British Journal of Anaesthesia"},{"key":"10.7717\/peerj.21764\/ref-30","doi-asserted-by":"publisher","first-page":"1424","DOI":"10.1111\/anae.15541","article-title":"PROSPECT guidelines for total hip arthroplasty: a systematic review and procedure-specific postoperative pain management recommendations","volume":"76","author":"Robin","year":"2021","journal-title":"Anaesthesia"},{"key":"10.7717\/peerj.21764\/ref-31","doi-asserted-by":"publisher","first-page":"e0182471","DOI":"10.1371\/journal.pone.0182471","article-title":"Pre-existing weakness is critical for the occurrence of postoperative cognitive dysfunction in mice of the same age","volume":"12","author":"Tang","year":"2017","journal-title":"PLOS ONE"},{"key":"10.7717\/peerj.21764\/ref-32","doi-asserted-by":"publisher","first-page":"1119667","DOI":"10.3389\/fnmol.2023.1119667","article-title":"Ultrasound-guided anterior iliopsoas muscle space block effectively reduces intraoperative hypotension in elderly adults undergoing hip surgery: a randomised controlled trial","volume":"16","author":"Teng","year":"2023","journal-title":"Frontiers in Molecular Neuroscience"},{"key":"10.7717\/peerj.21764\/ref-33","doi-asserted-by":"publisher","first-page":"1289","DOI":"10.1093\/gerona\/glv083","article-title":"Cytokines and postoperative delirium in older patients undergoing major elective surgery","volume":"70","author":"Vasunilashorn","year":"2015","journal-title":"Journals of Gerontology, Series A: Biological Sciences and Medical Sciences"},{"key":"10.7717\/peerj.21764\/ref-34","doi-asserted-by":"publisher","first-page":"S2","DOI":"10.1016\/j.pain.2010.09.030","article-title":"Central sensitization: implications for the diagnosis and treatment of pain","volume":"152","author":"Woolf","year":"2011","journal-title":"Pain"}],"container-title":["PeerJ"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/peerj.com\/articles\/21764.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21764.xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21764.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/peerj.com\/articles\/21764.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T08:48:23Z","timestamp":1790758103000},"score":1,"resource":{"primary":{"URL":"https:\/\/peerj.com\/articles\/21764"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,30]]},"references-count":34,"alternative-id":["10.7717\/peerj.21764"],"URL":"https:\/\/doi.org\/10.7717\/peerj.21764","archive":["CLOCKSS","LOCKSS","Portico"],"relation":{},"ISSN":["2167-8359"],"issn-type":[{"value":"2167-8359","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,30]]},"article-number":"e21764"}}