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USG Guided Lumbosacral Plexus Block for Surgery for Fracture Hip in High-Risk Patients– A Retrospective Case Series

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Vol 5 | Issue 1 | January-June 2024 | Page 14-17| Harshal D Wagh , Chetan Salunkhe , Mitalee Pareek , Senthil Kumar

DOI: https://doi.org/10.13107/ijra.2024.v05.i01.085

Authors: Harshal D Wagh [1], Chetan Salunkhe [1], Mitalee Pareek [1], Senthil Kumar [1]

 

[1] Department of Anaesthesia, Kokilaben Dirubhai Ambani Hospital, Mumbai, Maharashtra, India.

Address of Correspondence

Dr. Mitalee Pareek
Department of Anaesthesia, Kokilaben Dirubhai Ambani Hospital, Mumbai, Maharashtra, India.
E-mail: pareekmitalee@gmail.com

Abstract

Background 1.6 million patients worldwide are victims of hip fracture. The incidence is expected to rise with ageing of world’s population. Elderly patients with hip fracture pose a medical challenge for the anesthesiologist and are often associated with high incidence of morbidity and mortality. Early surgical fixation of fractured joint is necessary to reduce associated morbidity. Advanced age and delayed surgical correction and medical history are independent factors determining 1 year mortality after hip fixation which is 23.9% in these patients.

Objective: In this case series where we share our experience of fracture femur fixation performed under USG guided combined lumbosacral block for 19 patients of ASA 3/4 physical status.

Method: Hip fracture fixation was performed under USG guided and neurostimulation technique Lumbar plexus and Para-sacral sciatic nerve block with 20 ml and 15 ml of 0.3% Ropivacaine respectively. All patients were shifted to ICU for further care.

Conclusion: USG guided Lumbosacral plexus block for surgeries around the hip joint can be used as a sole anesthetic in high-risk patients. Detailed preoperative evaluation and optimization, vigilant patient selection, counselling, monitoring, providing optimum drug dosage are key for success.

Keywords: Lumbosacral plexus block, Hip fracture, USG-guided

References

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How to Cite this Article: Wagh HD, Salunkhe C, Pareek M, Kumar S | USG Guided Lumbosacral Plexus Block for Surgery for Fracture Hip in High-Risk Patients– A Retrospective Case Series Block | International Journal of Regional Anaesthesia | January-June 2024; 5(1): 14-17 | DOI: https://doi.org/10.13107/ijra.2024.v05.i01.85

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USG Guided Forearm Nerve Block

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Vol 2 | Issue 1 | January-June 2021 | Page 72-77 | Madhuri Dadke, Sandeep Diwan

Authors: Madhuri Dadke [1], Sandeep Diwan [1]

[1] Department of Anaesthesia, Sancheti Hospital, Pune, Maharashtra, India.

Address of Correspondence
Dr. Sandeep Diwan,
Consultant Anaesthesiologist, Sancheti Hospital, Pune, Maharashtra, India.
E-mail: sdiwan14@gmail.com

Introduction

Forearm blocks (FAB) are implemented to provide anaesthesia for hand surgeries, as a rescue block for failed or patchy proximal brachial plexus block and to provide postoperative analgesia after a regional or a general anaesthetic [1]. The advantage of these distal blocks is preservation of proximal motor function and avoidance of central structures such as the pleura, subclavian or axillary artery and the phrenic nerve. The proximal muscle function is preserved with these blocks, requiring minimal doses of local anaesthetic. These blocks can be implemented in outpatients [2] and with patients on anticoagulants [3]. Distal nerve blocks do not prevent tourniquet pain since the lateral antebrachial cutaneous nerve of forearm (musculocutaneous nerve), the medial cutaneous nerve of the arm, the posterior cutaneous nerve of the arm, and the intercostobrachial nerve that provide cutaneous innervation of the upper arm are not blocked [4]. The above mentioned nerves are blocked in the arm. Blockade of multiple nerves are needed and so involves multiple injections that may cause more patient discomfort.

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How to Cite this Article: Dadke M, Diwan S | USG Guided Forearm Nerve Block | International Journal of Regional Anaesthesia | January- June 2021; 2(1): 72-77.

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