Rajesh Kumar Singh1, J P Chaturvedi2, H S Agrawal3, Nitesh Agrawal4. 1. Senior Adviser (Anaesthesiology), Military Hospital Kirkee, Pune 411040, India. 2. Classified Specialist (Anaesthesiology), Military Hospital Allahabad, Uttar Pradesh, India. 3. Consultant (Surgery & Orthopaedics) & Commandant, Military Hospital Kirkee, Pune 411040, India. 4. Graded Specialist (Anaesthesiology), 187 Military Hospital, C/O 56 APO, India.
Abstract
BACKGROUND: Aging causes progressive deterioration of all the organ systems. Physiological changes of aging and co-morbidities make regional anesthesia a preferred technique for this age group. Regional anesthesia with risk of hypotension and its consequences is fraught with dangers. Peripheral nerve blocks (PNBs) are much safer and give much superior post-op analgesia. The present study was undertaken to perform major lower limb orthopedic surgeries PNBs in geriatric settings. METHODS: A feasibility study was undertaken in patients above age of 60 years admitted for lower limb surgeries to undertake these surgeries under para-vertebral blocks for a period of one year from Mar 2011 to Feb 2012. RESULTS: The responses and results of 203 eligible patients averaging 69.5 years. Mean duration of surgical procedure was 174.6 min and surgical analgesia was 334.5 min. Mean time of analgesic supplementation postoperative 398.3 min. The incidence of adverse effects (hypotension) requiring intervention was 5 out of 203, failure rate 2 out of 203. CONCLUSION: All major lower limb surgeries can be done under combined lumbar and sacral plexus block with additional supplementation for the skin at the line of incision especially in case the surgery involving hip with intercostal block at 11th ICS. The study strongly recommends it as a technique of choice in geriatric cases rather than reserving it for only moribund cases.
BACKGROUND: Aging causes progressive deterioration of all the organ systems. Physiological changes of aging and co-morbidities make regional anesthesia a preferred technique for this age group. Regional anesthesia with risk of hypotension and its consequences is fraught with dangers. Peripheral nerve blocks (PNBs) are much safer and give much superior post-op analgesia. The present study was undertaken to perform major lower limb orthopedic surgeries PNBs in geriatric settings. METHODS: A feasibility study was undertaken in patients above age of 60 years admitted for lower limb surgeries to undertake these surgeries under para-vertebral blocks for a period of one year from Mar 2011 to Feb 2012. RESULTS: The responses and results of 203 eligible patients averaging 69.5 years. Mean duration of surgical procedure was 174.6 min and surgical analgesia was 334.5 min. Mean time of analgesic supplementation postoperative 398.3 min. The incidence of adverse effects (hypotension) requiring intervention was 5 out of 203, failure rate 2 out of 203. CONCLUSION: All major lower limb surgeries can be done under combined lumbar and sacral plexus block with additional supplementation for the skin at the line of incision especially in case the surgery involving hip with intercostal block at 11th ICS. The study strongly recommends it as a technique of choice in geriatric cases rather than reserving it for only moribund cases.