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54 Low-dose, opioid-free subarachnoid block and US-guided suprainguinal FICB as an anaesthetic/analgesic technique in patients with asymptomatic, mild to moderate aortic stenosis undergoing hip fracture surgery
  1. H Abrahams and
  2. R Matos-Puig
  1. GJGM Regional Hospital, Stanger, South Africa


Background and Aims Aortic Stenosis (AS) is a relatively common valvular lesion in patients over 75.The significant risks associated with surgery may be mitigated by choice of anaesthetic technique and careful perioperative planning. Haemodynamic goals broadly aim to avoid hypotension and tachycardia and to preserve coronary perfusion pressure and systemic vascular resistance. Neuraxial blockade is traditionally taught to be a (relative) contraindication in this particular group of patients.

Aim: To assess perioperative pain scores and intraoperative hypotension after a technique comprising a low-dose, slow-titrated SAB and US-guided SIFI FICB in patients with mild-moderate disease as evidenced on TTE undergoing hip fracture surgery.

Methods IRB was obtained.

8 patients were enrolled prospectively over 6 months (Nov 2019 – April 2020)

All patients had a preoperative TTE to categorise disease severity.

Invasive arterial monitoring was instituted preoperatively in all patients.

US-guided SIFI FICB followed by a SAB (25G pencil point needle) was performed.

(30 ml 0.25% isobaric Bupivicaine and 7.5 mg hyperbaric Bupivicaine x 1 min, respectively).

No opioids were used.

Vasopressor boluses (Phenylephrine 50 mcg/ml) were administered if the MAP dropped by 10% of the initial value.

The number of bolused episodes was recorded.

All patients received an IV balanced crystalloid (10 ml/kg) at SAB insertion, followed by an infusion.

Pain scores (VAS) were documented perioperatively.


  1. Slowly titrated, low–dose SAB in elderly patients with mild–moderate, asymptotic AS did not develop precipitous hypotension.

  2. MAP was relatively easily maintained with boluses of Phenylephrine (50mcg/ml).

  3. US–guided SIFI FICB is an effective analgesic adjunct.

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