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Abstract
Background and Aims Hip fractures pose challenges in patient management, especially when surgical risks outweigh benefits. Inadequate analgesia from conservative treatment options prompted the development of new procedures targeting hip capsule denervation. We aimed to evaluate the efficacy of chemical neurolysis as a conservative treatment for hip fractures, within our department’s protocol.
Methods Patients who were deemed inoperable by either the orthopedists or anesthesiologist were evaluated for eligibility criteria and informed consent was obtained. A diagnostic block was performed under ultrasound guidance using 5 mL of 2% lidocaine in the pericapsular nerve group plane. With the needle in situ, the block’s efficacy was evaluated by performing flexion, internal and external rotation of the hip joint. If the block was deemed positive, the needle’s location was confirmed, and 6 mL of 99% alcohol was administered. Prior to needle removal, 1 mL of local anesthetic was flushed through the needle.
Results During the one-year period from May 2022 to May 2023, a total of five patients (aged 55 to 96) underwent the procedure. All were previously unable to ambulate. At the 1-day follow-up, one patient experienced pain, which resolved by the 5-day evaluation. None of the patients reported pain at the 5-day follow-up, and all were discharged pain-free. There were no reported adverse effects. Follow-up was scheduled in outpatient orthopedic consultations.
Ultrassonography lankmarks for identifying the pericapsular nerve group plane include the antero-inferior iliac spine (bottom left corner), the ielo- pubic eminence (bottom center), and the psoas muscle tendon (above the previous)
Under ultrassound guidance, the needle is advanced immediately lateral to the antero-inferior iliac spine and positioned between the ileo-pubic eminence and the psoas muscle tendon. The spread of the injected substance along with the superior desplacement of the psoas tendon can be observed
Conclusions Chemical neurolysis seems to provide effective and safe conservative treatment for hip fractures, offering reliable analgesia for non-surgical candidates. Effective collaboration between orthopedic and anesthesiology teams was vital for high-quality patient care.