TY - JOUR
AU1 - Seidel, Ronald
AU2 - Barbakow, Eduard
AU3 - Schulz-Drost, Stefan
AB - Abstract Background and objective Due to changing demographics geriatric patients with multiple comorbidities and proximal femoral fractures are an increasing patient population. In these patient groups, peripheral regional anesthesia could become increasingly more important besides established procedures, such as neuraxial or general anesthesia. The aim of this single center feasibility study was to evaluate a combined blockade technique of the lumbosacral plexus for three predefined subgroups depending on the type of hip fracture. Methods We used a unilateral double injection three-step technique to block the sacral (parasacral block) and lumbar plexus (anterior quadratus lumborum and psoas compartment block, n = 78). The blockade was performed both under ultrasound guidance and simultaneous nerve stimulation and 20 ml ropivacaine 0.375% was injected at each of the 3 injection sites (total dose 225 mg). Results In 42% of cases the surgery was opioid-free (n = 33). In 5 patients a conversion to general anesthesia (insertion of a laryngeal mask and pressure-controlled or pressure-supported ventilation) was necessary (6%). The overall success rate of combination anesthesia (peripheral nerve blocks with supplemental sedative (propofol 1–2 mg/kg*h) or analgesic (incremental doses of 5 µg sufentanil) medication) was 94%, regardless of fracture type and surgical treatment. Conclusion The combined anesthetic technique presented in this study enables surgical treatment of proximal femoral fractures. The associated effort and requirement for expert knowledge in regional anesthesia indicates that this method should be considered especially in cases with high anesthetic risk, suitable sonoanatomy, and non-compromised coagulation.
TI - Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia
JF - Der Anaesthesist
DO - 10.1007/s00101-021-00935-6
DA - 2021-12-01
UR - https://www.deepdyve.com/lp/springer-journals/surgical-treatment-of-proximal-femoral-fractures-in-high-risk-FLC5UPdFvG
SP - 1022
EP - 1030
VL - 70
IS - 12
DP - DeepDyve
ER -