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#36491 Alternative methods for analgesia in a polytraumatic pediatric patient with a hip fracture, contraindicated for opioids
  1. Albena Atanasova,
  2. Ivanka Buchakchieva,
  3. Denis Ismet and
  4. Bogdan Mladenov
  1. Department of Pediatric Anesthesiology and Intensive Care Unit, UMHATEM N.I.Pirogov, Sofia, Bulgaria


Please confirm that an ethics committee approval has been applied for or granted: Yes: I’m uploading the Ethics Committee Approval as a PDF file with this abstract submission

Application for ESRA Abstract Prizes: I apply as an Anesthesiologist (Aged 35 years old or less)

Background and Aims Hip fractures in young individuals and children often occur due to high-energy injuries such as traffic accidents or falls from heights, often accompanied by polytrauma. Managing the intense pain in these patients and ensuring hemodynamic stability calls for a multimodal approach to pain control, both during surgery and throughout their stay in the ICU. External fixation through the traction method is typically employed to stabilize the patient‘s leg. We present a 16 years old polytraumatic patient with a hip fracture who also had a medical history of chronic use of psychoactive substances. The patient had a diagnosis of schizophrenia and was receiving aripiprazole therapy. The patient‘s chronic use of psychoactive substances, in combination with the synergistic effect of opioids, tramadol, and aripiprazole, posed a risk for tolerance development, necessitating the exploration of alternative methods for analgesia.

Methods We utilized an ultrasound-guided femoral nerve catheter to administer a continuous infusion of Ropivacaine 0.125% at a rate of 6ml/h. Assessment of the level of analgesia was done using pain scales- VAS,NRS.

Results During the patient‘s ICU stay, no additional intravenous analgesics were required, except for the standard pain relievers supplemented with non- steroidal anti-inflammatory drugs

Conclusions The femoral catheter proved to be a simple, effective, and relatively safe method of analgesia. The ultrasound-guidance of the technique allowed for precise monitoring of local anesthetic spread, needle and catheter placement, and helped mitigate potential risks and complications.It represents a favorable choice for providing analgesia in polytraumatic patients with hip fractures and risk of opioid tolerance

Attachment Ethic Comittee. Hip fracture pdf.pdf

  • low extremities blocks
  • multimodal analgesia
  • regional analgesia
  • femoral catheter

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