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PERIPHERAL NERVE BLOCK FOR PROXIMAL FEMORAL FRACTURE SURGERY IN A PATIENT WITH SEVERE AORTIC STENOSIS
ESRA Academy. Faísco A. Sep 8, 2016; 138512; 0375 Topic: Peripheral Nerve Blocks
Dr. Ana Faísco
Dr. Ana Faísco

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Abstract
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Background and Aims:

Proximal femoral fractures present unique challenges for anesthesia related to perioperative care of older patients with significant comorbidities. The gold standard anesthetic technique for osteosynthesis of proximal femoral fractures is neuraxial blockade. Severe aortic stenosis is a risk factor for perioperative mortality due to rapid hemodynamic deterioration and is a relative contraindication for neuraxial blockade.  We present an alternative anesthetic technique for patients undergoing proximal femoral fracture surgery.

Methods:

A 73-year-old man, ASA physical status 4, was admitted for osteosynthesis of a trochanteric fracture. He had severe aortic stenosis, coronary artery disease, cardiac heart failure, and chronic obstructive lung disease with acute bronchitis. We performed a femoral, lateral femoral cutaneous and transgluteal sciatic nerve block under ultrasonic guidance, with ropivacaine 0,5%.

Intraoperatively was administered sufentanyl 5 mcg and a sedation with propofol 2mg/kg/h. One month later the patient was admitted for debridement and removal of the infected osteosynthesis material and external fixation. The same anesthetic approach was performed. Both procedures were uneventful.

Pain scores were evaluated by numerator rating scale for the first 24 h following both surgeries. Administration of rescue analgesics and adverse effects were recorded during the same period.

Results:

The patient did not require rescue analgesics or anesthetics during intervention. No complications related to the peripheral blocks were recorded. Pain scores were 0/10 for the first 24h.

Conclusions:

From this case report this seems to be an effective alternative for femoral fractures surgery in cases where either neuraxial blocks or general anesthesia have considerable risks. 

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