Association of ultrasound-guided fascia iliaca compartment block with sedation and postoperative nausea and vomiting in elderly patients undergoing hip arthroplasty: A retrospective propensity score–matched cohort study

This study aimed to compare the association of ultrasound-guided fascia iliaca compartment block (FICB) with sedation versus conventional general anesthesia (GA) with postoperative nausea and vomiting (PONV) in elderly patients undergoing hip arthroplasty. This retrospective propensity score–matched cohort study included patients aged ≥ 60 years who underwent elective unilateral hip arthroplasty between March 2022 and March 2024. Patients were classified according to the anesthesia technique received: ultrasound-guided FICB with dexmedetomidine-based sedation or conventional endotracheal GA. Propensity score matching was performed to balance baseline characteristics. The primary outcome was the incidence of PONV within 24 hours postoperatively. Secondary outcomes included PONV requiring pharmacological intervention, early PONV within 0 to 6 hours, opioid consumption, time to first analgesic request, post-anesthesia care unit (PACU) stay, time to ambulation, and anesthesia-related adverse events. After matching, 100 patients were included, with 50 patients in each group. The FICB-sedation group had a lower 24 hours PONV incidence than the GA group (16.0% vs 42.0%, P  = .004), corresponding to an absolute risk reduction of 26.0% and a number needed to treat of approximately 4. PONV requiring pharmacological intervention was also lower in the FICB-sedation group (14.0% vs 36.0%, P  = .012), as was early PONV within 0 to 6 hours postoperatively (10.0% vs 30.0%, P  = .012). The FICB-sedation group showed reduced intraoperative and postoperative opioid consumption, delayed first analgesic request, shorter PACU stay, and earlier ambulation. In multivariable logistic regression, FICB with sedation was independently associated with a lower risk of PONV, whereas higher postoperative opioid consumption was associated with increased PONV risk. The incidence of intraoperative hypotension was lower in the FICB-sedation group. In elderly patients undergoing hip arthroplasty, ultrasound-guided FICB with sedation was associated with a lower incidence and severity of PONV, reduced opioid consumption, faster early recovery, and improved intraoperative hemodynamic stability compared with conventional GA. Given the retrospective single-center design, these findings should be interpreted as associative and require confirmation in prospective randomized studies.