Save
PERIPHERAL NERVE BLOCKS FOR SURGICAL ANESTHESIA OF HIP FRACTURE IN A PATIENT WITH SEVERE CARDIOPULMONARY COMORBIDITIES AND ANTICOAGULATION
Author(s): ,
Tang, T.Y.*
Affiliations:
Taichung Veterans General Hospital, Anesthesiology, Taichung, Taiwan R.O.C.
,
Liou, J.Y.
Affiliations:
Columbia University, Department of Physiology and Cellular Biophysics, New York, USA
,
Chiang, K.L.
Affiliations:
Taichung Veterans General Hospital, Anesthesiology, Taichung, Taiwan R.O.C.
,
Wu, C.C.
Affiliations:
Taichung Veterans General Hospital, Anesthesiology, Taichung, Taiwan R.O.C.
Hung, C.J.
Affiliations:
Taichung Veterans General Hospital, Anesthesiology, Taichung, Taiwan R.O.C.
ESRA Academy. Tang T. Sep 16, 2017; 196151; esra7-0025
Tsung-Yung Tang
Tsung-Yung Tang
Login now to access Regular content available to all registered users.

Access to Premium content is currently a membership benefit.


Click here to join ESRA or renew your membership.


Abstract
Discussion Forum (0)
Rate & Comment (0)
Background and Aims:

The application of general or neuraxial anesthesia is standard practice for hip fracture surgeries, however, geriatric patients, due to a high prevalence of comorbidities, are often at high risk of anesthesia-related complications. Peripheral nerve blockade (PNB), though technically challenging, may reduce the risk of such complications. Here, we report our experience applying PNB to a multi-comorbid geriatric patient with right intertrochanteric fracture who underwent ORIF with cephalomedullary nail. 

Methods:

This is a 68-year-old man, ASA-III, with complicated history: 1. CAD-3, STEMI post balloon angioplasty and bare metal stent; 2. Atrial fibrillation, receiving warfarin; 3. Right lung abscess post surgery with significant lung volume reduction(Fig.1); 4. COPD; 5. DM; 6. ESRD, receiving regular hemodialysis. After obtaining informed consent, we performed comprehensive PNB on femoral, obturator, lateral femoral cutaneous, and sciatic nerves(para-sacral approach). Regimens used are listed in Table1. Despite the administration of extensive PNB, no systemic toxicity was noted. 

Results:

A good quality of anesthesia was obtained. Midazolam 2mg and continuous infusion of propofol were administered for sedation after ensuring success of nerve blockade. Total consumption of propofol was only 320mg during the 150-minute operative period. Intraoperative hemodynamics were stable without episode of apnea or hypoxia. Analgesia on the 1st and 2nd postoperative day was achieved with tramadol-acetaminophen(Ultracet ®) QID only, and the pain intensity evaluated by NRS was around 2 to 3.

Conclusions:

Ultrasound-guided PNB can achieve safe and satisfactory anesthesia for hip surgeries. For patients at significant risks of general and neuraxial anesthesia, ultrasound-guided PNB is probably a better alternative. 

Code of conduct/disclaimer available in General Terms & Conditions
Anonymous User Privacy Preferences

Strictly Necessary Cookies (Always Active)

MULTILEARNING platforms and tools hereinafter referred as “MLG SOFTWARE” are provided to you as pure educational platforms/services requiring cookies to operate. In the case of the MLG SOFTWARE, cookies are essential for the Platform to function properly for the provision of education. If these cookies are disabled, a large subset of the functionality provided by the Platform will either be unavailable or cease to work as expected. The MLG SOFTWARE do not capture non-essential activities such as menu items and listings you click on or pages viewed.


Performance Cookies

Performance cookies are used to analyse how visitors use a website in order to provide a better user experience.



Google Analytics is used for user behavior tracking/reporting. Google Analytics works in parallel and independently from MLG’s features. Google Analytics relies on cookies and these cookies can be used by Google to track users across different platforms/services.


Save Settings