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Poster displayed – Central nerve blocks
P087 Case report: much more than a hip fracture
  1. Luciana Minieri1,
  2. Carmelinda Di Matteo2,
  3. Alessia Cipriani3,
  4. Antonella Topo2,
  5. Roberto Carlucci4 and
  6. Mario Bosco5
  1. 1Orthopedic Anesthesiologist Referent, San Filippo Neri Hospital -ASL ROMA 1, ROMA, Italy
  2. 2Anesthesiologist, San Filippo Neri Hospital – ASL Roma 1, Rome, Italy
  3. 3Anesthesiologist, San Filippo Neri Hospital – ASL Roma 1, Rome, Italy
  4. 4Anesthesiology Operating Room Haed, San Filippo Neri Hospital -ASL ROMA 1, Rome, Italy
  5. 5Anesthesiology Department Chief, ASL Roma 1, Rome, Italy

Abstract

Please confirm that an ethics committee approval has been applied for or granted: Not relevant (see information at the bottom of this page)

Background and Aims Frail patients with hip fracture recommended for immediate surgery often present difficult spinal anatomy, which requires special expertise in performing ultrasound-assisted neuraxial block.

Methods The patient (male, 71years, 60kg, 165cm tall after vertebral collapse, previously 180cm) was able to walk independently aided by a walking stick; an accidental fall caused left proximal femur fracture which required total hip arthroplasty the day after admission. ASA III/IV, El-Ganzouri score 6 (Mallampati 2, thyromental distance <6cm, neck movement <80°, questionable history of difficult intubation); no cognitive impairment. Medical History: Ipertension, Parkinson’s and Dysphagia, Myasthenia Gravis with moderate restrictive respiratory failure, history of respiratory arrest and pacemaker implant, severe kyphosis, vertebral collapse (T6-T12), bedsores (heels, back, sacrum). Within 1 hour from hospitalization paracetamol (1g/8 hours iv) was administered for analgesia and bedsores were routinely treated. Anaesthesia according to internal guidelines: - Ultrasound guided Peng Block with ropivacaine 0.5% 20ml, dexamethasone 8mg iv; - Ultrasound-assisted neuraxial block while sitting upright L2-L3 (Whitacre needle 25G), ropivacaine 0,5% 15mg

Results No further complications: -Alimentation: semi-solid diet 4hours after surgery (dysphagia); -Analgesia: paracetamol (1g/8hours iv) for 5 days and ketorolac in rescue dose; -Rehabilitation: starting the 2nd day (patient able to walk), discharge on the 5th day, continuing rehabilitation at home. At 1 year check-up patient shows good condition, complete absence of bedsores and a full recovery.

Conclusions Our clinical case shows how adapting evidenced based medicine and internal guidelines to the specific clinical setting, taking advantage of new technologies, is key for optimal patient management.

Abstract P087 Figure 1
Abstract P087 Figure 1

x ray column, 24 months after right hip fracture and total hip arthroplasty in general anesthesia and intensive care (questionable history of difficult intubation); 1 year before left proximal femur fracture in Regional Anesthesia (case report)

Abstract P087 Figure 2
Abstract P087 Figure 2

Ultrasound assisted neuraxial block

Abstract P087 Figure 3
Abstract P087 Figure 3

1 year later patient able to walk independently aided by a walking stick, shows good condition and a full recovery

  • frail patient
  • ultrasuond- assisted neuraxial block
  • difficult intubation
  • medical history
  • physical examination
  • evidenced based medicine
  • internal guidelines

https://doi.org/10.1136/rapm-2024-ESRA.291

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