Background and aims Hip fracture is a common occurrence in the elderly and if surgery delayed may increase mortality further1. Hip hemiarthroplasty in elderly patients with multiple co-morbidities can be safely done under peripheral nerve blocks2. We present a case of hip arthroplasty of frail elderly gentleman successfully done under peripheral nerve blocks.
Methods 85 year old gentleman admitted hospital with fractured neck of femur following a fall with a background history of bronchiectasis, NYHA grade 3 heart failure with LVEF of 15% and moderate aortic stenosis, diabetic and hypothyroidism.
Considering his various risk factors, patient was consented for uncemented hemiarthroplasty under peripheral nerve blocks with sedation. With pre-operative blood pressure of 110/70 and saturation of 97% on 4 litre of oxygen, sedation was started with Propofol TCI. Femoral nerve block was done under ultrasound guidance and then sciatic nerve block in lateral position with nerve stimulator as sonoanatomy was unclear. Hemiarthroplasty was successfully completed with maximum of 1 mcg/ml of Propofol TCI and aliquots of alfentanil (total 1 mg) under peripheral nerve blocks and patient remained haemodynamically stable throughout.
Results Frail elderly patients with multiple co-morbidities may not tolerate haemodynamic instability associated with general or neuraxial anaesthesia. An understanding of surgical technique and regional anatomy is vital to provide an effective nerve block. Haemodynamic instability can be avoided by performing peripheral nerve blocks for hip hemiarthroplasty in high risk patients with cardiorespiratory disease.
Conclusions We conclude that hip hemiarthroplasty can be safely done under peripheral nerve block under minimal sedation in a patient with severe cardiorespiratory disease.
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