Comparison of the effect of preoperative continue femoral nerve block and paracetamol administration on preoperative pain management and postoperative delirium incidence of geriatric patients

Patients who are older than 65 years old and applied to emergency service with hip fracture diagnosis will be included in the study. All of the patients will be assessed for the presence of delirium with 16 items Delirium Rating Scale-Revised Version (DRS-R-98). The patients with preoperative delirium will be excluded from the study. The participants will receive 2 lt/minute oxygen supplementation and standard nutritional support. Preoperative hemoglobin level will be raised to 10 g/dl in all of the patients prior to the surgery. Then the patients will randomly be divided into two groups; in the first group, patients will receive 5 mg/kg paracetamol intraveously at every 8 hours until the operation day (maximum 48 hours). In the second group, a femoral nerve block will be done with the guidance of ultrasonography and a catheter will be inserted, then 0.5 ml/kg bupivacaine %0.25 will be administered through the femoral nerve catheter until the operation day (maximum 48 hours). The pain levels of the patients will be assessed using a 100mm visual analog scale four hours after the paracetamol administration in the first group and femoral block in the second group. If needed, intravenous tramadol 0.5 mg/kg will be applied as rescue analgesic in both of the groups. In the operating room, all of the patients will receive a spinal-epidural combined anesthesia as anesthetic management. The pain occurred related to positioning for regional anesthesia will be recorded using a 100mm visual analogue scale. During the dural puncture, 2 ml of cerebrospinal fluid will be taken for analysis of interleukin 6 and interleukin 8 levels with enzyme linked immunoassay. For spinal anesthesia, 10 mg bupivacaine and 20 mcg fentanyl will be applied intrathecaly. The postoperative analgesia will be managed with 5 ml/hour of bupivacaine 0.125% and 100 mcg fentanyl through the epidural catheter in all the patients. The patients will be assessed with DRS-R-98 for presence of delirium at postoperative first, second and third days.