Discussion
toxicity, fracture, POCD, pain, neurocognitive disorders, neurological complications
NEUROLOGICAL COMPLICATION, PATHOGENESIS, INFLAMMATORY RESPONSES, COMPLICATIONS
As common complications in the hip fracture older people population, neurological complications seriously threaten postoperative rehabilitation, decrease mobility, and increase the length of hospital stay [The MoCA is a commonly used cognitive screening method for patients in the early stages of neurocognitive disorders [It has been proved that both preoperative chronic and postoperative acute pain can impair postoperative cognitive function [It has been widely recognized that inflammatory responses play an essential role in the pathogenesis of POCD [Compared to the control group, the patients of the QLB group had a shorter time to first off-bed activity. This indicated that adequate postoperative analgesia provided by QLB could promote early postoperative rehabilitation of patients, consistent with a previous study performed by Kelly et al. [Also, there were certain limitations to this study. First, sensory testing in the QLB group was not performed to avoid unblinding. Second, the sample size was limited, and only MoCA testing was adopted to assess POCD in this study. Therefore, larger sample sizes and multiple tests with different domains of cognition should be performed in further research to gather more evidence. Third, intention-to-treat analysis should be adopted to evaluate the therapeutic effect or exclusion criteria should be modified to ensure that all subjects are eligible for QLB to improve the comparability of experimental results. Last, a dose of 90 mg of ropivacaine was used in this study, and no systemic toxicity was observed. Nevertheless, the ideal LA dosing, volumes, and optimal injection site of QLB in older people still need to be verified.