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

1] Ahamed Z A, Sreejit MS. Lumbar plexus block as an effective alternative to subarachnoid block for intertrochanteric hip fracture surgeries in the elderly. Anesth Essays Res 2019;13:264-8
2] Diwan S, Pradhan C, Patil A, Puram C, Sancheti P. Combined lumbar and sacral plexus block in geriatric high-risk patients undergoing an awake repair of fracture intertrochanteric of femur. Journal of Anaesthesia and Critical Care Case Reports Jan-April 2018; 4(1):21-30
3] Mannion S, Barrett J, Kelly D, Murphy DB, Shorten GD. A description of the spread of injectate after psoas compartment block using magnetic resonance imaging. Reg Anesth Pain Med. 2005 Nov-Dec;30(6):567-71. doi: 10.1016/j.rapm.2005.08.004. PMID: 16326342.
4] Parkinson SK, Mueller JB, Little WL, Bailey SL. Extent of blockade with various approaches to the lumbar plexus. Anesth Analg. 1989 Mar;68(3):243-8. PMID: 2919761
5] Capdevila X, Macaire P, Dadure C, Choquet O, Biboulet P, Ryckwaert Y, D’Athis F. Continuous psoas compartment block for postoperative analgesia after total hip arthroplasty: new landmarks, technical guidelines, and clinical evaluation. Anesth Analg. 2002 Jun;94(6):1606-13, table of contents. doi: 10.1097/00000539-200206000-00045. PMID: 12032037.
6] Guzon-Illescas O, Perez Fernandez E, Crespí Villarias N, Quirós Donate FJ, Peña M, Alonso-Blas C, García-Vadillo A, Mazzucchelli R. Mortality after osteoporotic hip fracture: incidence, trends, and associated factors. J Orthop Surg Res. 2019 Jul 4;14(1):203. doi: 10.1186/s13018-019-1226-6. PMID: 31272470; PMCID: PMC6610901.
7] Morri M, Ambrosi E, Chiari P, Orlandi Magli A, Gazineo D, D’ Alessandro F, Forni C. One-year mortality after hip fracture surgery and prognostic factors: a prospective cohort study. Sci Rep. 2019 Dec 10;9(1):18718. doi: 10.1038/s41598-019-55196-6. PMID: 31822743; PMCID: PMC6904473.
8] Zhang J, Wang X, Zhang H, Shu Z, Jiang W. Comparison of combined lumbar and sacral plexus block with sedation versus general anaesthesia on postoperative outcomes in elderly patients undergoing hip fracture surgery (CLSB-HIPELD): study protocol for a prospective, multicentre, randomised controlled trial. BMJ Open. 2019 Mar 30;9(3):e022898. doi: 10.1136/bmjopen-2018-022898. PMID: 30928924; PMCID: PMC6475153.
9] Honorio T. Benzon, Rasha S. Jabri, and Tom C. Van Zundert Neuraxial Anesthesia and Peripheral Nerve Blocks in Patients on Anticoagulants. https://www.nysora.com/foundations-of-regional-anesthesia/patient-management/neuraxial-anesthesia-peripheral-nerve-blocks-patients-anticoagulants/
10] Nielsen MV, Bendtsen TF, Børglum J. Superiority of ultrasound-guided Shamrock lumbar plexus block. Minerva Anestesiol. 2018 Jan;84(1):115-121. doi: 10.23736/S0375-9393.17.11783-9. Epub 2017 Jul 26. PMID: 28749094.
11] Taha AM. A simple and successful sonographic technique to identify the sciatic nerve in the parasacral area. Can J Anaesth. 2012 Mar;59(3):263-7. doi: 10.1007/s12630-011-9630-3. Epub 2011 Dec 3. PMID: 22139964.
12] Bendtsen TF, Lönnqvist PA, Jepsen KV, Petersen M, Knudsen L, Børglum J. Preliminary results of a new ultrasound-guided approach to block the sacral plexus: the parasacral parallel shift. Br J Anaesth. 2011 Aug;107(2):278-80. doi: 10.1093/bja/aer216. PMID: 21757560.
13] Huette P, Abou-Arab O, Djebara AE, Terrasi B, Beyls C, Guinot PG, Havet E, Dupont H, Lorne E, Ntouba A, Mahjoub Y. Risk factors and mortality of patients undergoing hip fracture surgery: a one-year follow-up study. Sci Rep. 2020 Jun 15;10(1):9607. doi: 10.1038/s41598-020-66614-5. PMID: 32541939; PMCID: PMC7296002.
14] Uma Shastri, Kwesi Kwofie, Emine Aysu Salviz, Daquan Xu, Admir Hadzic. 54 – Lower Extremity Nerve Blocks,Editor(s): Honorio T. Benzon, James P. Rathmell, Christopher L. Wu, Dennis C. Turk, Charles E. Argoff, Robert W. Hurley, Practical Management of Pain (Fifth Edition)2014, Pages 732-744.e2, https://doi.org/10.1016/B978-0-323-08340-9.00054-2.

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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