Background and Aims Spinal anaesthesia using bupivacaine with opioids is commonly used in fractured neck of femur surgery(1,2). However this often results in a prolonged sympathetic block in the elderly causing significant hypotension which may require vasopressor support. Newer local anaesthetic agents such as prilocaine and chloroprocaine are already successfully used in elective orthopaedics and offer better cardiovascular stability with faster recovery(3,4). We decided to assess the suitability of these newer agents in neck of femur surgery and review its outcomes.
Methods 200 patients having fractured neck of femur surgery were given spinal anaesthesia using either 2% prilocaine or 1% 2-chloroprocaine for Hemiarthoplasty or Dynamic hip screw respectively. An additional femoral/lat. cutaneous nerve/fascial iliaca block was performed at the start to allow patient positioning and provide an adjunct to increase the surgical operating time along with propofol sedation.
Results All patients had their surgery successfully without any conversions to general anaesthesia. We observed better cardiovascular stability intraoperatively and in recovery the blood pressure recording had returned to preoperative levels without any vasopressor support allowing faster recovery and discharge to the ward.
Conclusions We have shown that shorter acting spinal anesthetics can be used in neck of femur surgery successfully when combined with nerve blocks. But more importantly these agents offer significant advantages over bupivacaine by providing better heamodynamic stability and faster recovery whilst also avoiding hypotension once the patient has left the recovery area. More research is desperately needed to identify if these agents could improve mortality and if they should be adopted into international guidelines.
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