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Abstract
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Background and Aims Elderly patients with hip fractures pose a medical challenge for the anesthesiologist due to the high incidence of perioperative morbidity and mortality associated. Spinal and general anesthesia represent potencial options for surgery in terms of safety and acceptability for most patients without contraindications. The choice should be made based on the anaesthesiologist clinical experience, the individual patient’s requirements, comorbidities and the potential postoperative complications, consulting the geriatrician and orthopaedic surgeon.
Methods A 70-year-old male, with hip fracture was proposed for hemiarthoplasty. Medical history: ASA IV, COPD Gold 3, lung cancer ( left lower lobectomy), cerebellar metastases with dysphagia and brainstem compression. Surgery was indicated one month after admission due to a respiratory failure caused by a severe pneumonia. Baseline arterial oxygen saturation (SaO2) 92% (nasal cannula 4 L/min). We decided underwent surgery under ultrasound and nerve stimulation-guided lumbar plexus block and para-sacral sciatic nerve block using ropivacaine 0,5% + dexametasone 4mg (20ml/block) and sedoanalgesia with propofol-ketamine.
Results The procedure was well tolerated remaining SaO2 at his basal values, with stable intraoperative hemodynamics and adequate postoperative analgesia, without complications related to blockades.
Conclusions The performance of a lumbar plexus block with para-sacral sciatic nerve block combined with propofol-ketamine intravenous infusion for sedoanalgesia could be a good anesthetic-analgesic management for hip fracture surgery in high-risk patients, or when contraindication for neuraxial block exists and the risk for general aneshtesia is increased.
Lumbar plexus block landmarks
Para-sacral Sciatic nerve block landmarks