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Abstract
Background and aims According to the National Institutes of Health, the elderly population comprised 8.5% of the entire population in 2016, mostly coming from Asia, and this is expected to double in 35 years. The majority of them undergo hip surgeries for osteoporotic fractures. There is the little in the literature on the anesthetic management of an extremely old age (>100 years) and these suggest that routine anesthetic care may be neurotoxic to a vulnerable brain. This paper presents the use of combined lumbar and sacral plexus block in a 110-year-old female – a rare case considering her age, with impaired pulmonary and renal function, and kypholordosis, who undergone an elective right hip surgery (dynamic hip screw).
Methods An out-of-plane approach with dual guidance from ultrasound and nerve stimulator was used for lumbar and sacral plexus block. After infiltration of local anesthetic, complete motor and sensory block of the right thigh was achieved after 20 minutes.
Results The anesthesia provided by the lumbar and sacral plexus block lasted for 4 hours with minimal pain in the postoperative period. The patient was discharged 2 days after surgery and was able to ambulate with a walker.
Timeline of Patient Care in the Perioperative Period.Abbreviations: hb, hemoglobin; hct, hematocrit; BUN, blood urea nitrogen; IV, intravenous; ECG, electrocardiography; prn, as needed.
Photo during a lumbosacral plexus block (ultrasound and nerve stimulator-guided) of a patient in a left lateral decubitus position
Conclusions Combined lumbar and sacral plexus block can be used as a sole anesthetic technique in hip surgery. It is considered safe in elderly patients who cannot tolerate general and central neuraxial anesthesia.