Ronald Seidel1, Eduard Barbakow2, Stefan Schulz-Drost3. 1. Department of Anesthesiology and Intensive Care, Asklepios Medical Center Schwedt/Oder, Am Klinikum 1, 16303, Schwedt, Germany. ronald-seidel@t-online.de. 2. Department of Anesthesiology, Helios Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany. 3. Department for Trauma and Reconstructive Surgery, Helios Medical Center Schwerin, Wismarsche Straße 393-7, 19049, Schwerin, Germany.
Abstract
BACKGROUND AND OBJECTIVE: Due to changing demographics geriatric patients with multiple comorbidities and proximal femoral fractures are an increasing patient population. In these patient groups, peripheral regional anesthesia could become increasingly more important besides established procedures, such as neuraxial or general anesthesia. The aim of this single center feasibility study was to evaluate a combined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture. METHODS: We used a unilateral double injection three-step technique to block the sacral (parasacral block) and lumbar plexus (anterior quadratus lumborum and psoas compartment block, n = 78). The blockade was performed both under ultrasound guidance and simultaneous nerve stimulation and 20 ml ropivacaine 0.375% was injected at each of the 3 injection sites (total dose 225 mg). RESULTS: In 42% of cases the surgery was opioid-free (n = 33). In 5 patients a conversion to general anesthesia (insertion of a laryngeal mask and pressure-controlled or pressure-supported ventilation) was necessary (6%). The overall success rate of combination anesthesia (peripheral nerve blocks with supplemental sedative (propofol 1-2 mg/kg*h) or analgesic (incremental doses of 5 µg sufentanil) medication) was 94%, regardless of fracture type and surgical treatment. CONCLUSION: The combined anesthetic technique presented in this study enables surgical treatment of proximal femoral fractures. The associated effort and requirement for expert knowledge in regional anesthesia indicates that this method should be considered especially in cases with high anesthetic risk, suitable sonoanatomy, and non-compromised coagulation.
BACKGROUND AND OBJECTIVE: Due to changing demographics geriatric patients with multiple comorbidities and proximal femoral fractures are an increasing patient population. In these patient groups, peripheral regional anesthesia could become increasingly more important besides established procedures, such as neuraxial or general anesthesia. The aim of this single center feasibility study was to evaluate a combined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture. METHODS: We used a unilateral double injection three-step technique to block the sacral (parasacral block) and lumbar plexus (anterior quadratus lumborum and psoas compartment block, n = 78). The blockade was performed both under ultrasound guidance and simultaneous nerve stimulation and 20 ml ropivacaine 0.375% was injected at each of the 3 injection sites (total dose 225 mg). RESULTS: In 42% of cases the surgery was opioid-free (n = 33). In 5 patients a conversion to general anesthesia (insertion of a laryngeal mask and pressure-controlled or pressure-supported ventilation) was necessary (6%). The overall success rate of combination anesthesia (peripheral nerve blocks with supplemental sedative (propofol 1-2 mg/kg*h) or analgesic (incremental doses of 5 µg sufentanil) medication) was 94%, regardless of fracture type and surgical treatment. CONCLUSION: The combined anesthetic technique presented in this study enables surgical treatment of proximal femoral fractures. The associated effort and requirement for expert knowledge in regional anesthesia indicates that this method should be considered especially in cases with high anesthetic risk, suitable sonoanatomy, and non-compromised coagulation.
Authors: Laura Girón-Arango; Philip W H Peng; Ki Jinn Chin; Richard Brull; Anahi Perlas Journal: Reg Anesth Pain Med Date: 2018-11 Impact factor: 6.288
Authors: Anthony J Short; Jessi Jo G Barnett; Michael Gofeld; Ehtesham Baig; Karen Lam; Anne M R Agur; Philip W H Peng Journal: Reg Anesth Pain Med Date: 2018-02 Impact factor: 6.288
Authors: Ana Kowark; Christian Adam; Jörg Ahrens; Malek Bajbouj; Cornelius Bollheimer; Matthias Borowski; Richard Dodel; Michael Dolch; Thomas Hachenberg; Dietrich Henzler; Frank Hildebrand; Ralf-Dieter Hilgers; Andreas Hoeft; Susanne Isfort; Peter Kienbaum; Mathias Knobe; Pascal Knuefermann; Peter Kranke; Rita Laufenberg-Feldmann; Carla Nau; Mark D Neuman; Cynthia Olotu; Christopher Rex; Rolf Rossaint; Robert D Sanders; Rene Schmidt; Frank Schneider; Hartmut Siebert; Max Skorning; Claudia Spies; Oliver Vicent; Frank Wappler; Dieter Christian Wirtz; Maria Wittmann; Kai Zacharowski; Alexander Zarbock; Mark Coburn Journal: BMJ Open Date: 2018-10-18 Impact factor: 2.692