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Bali C, Ozmete O. Supra-inguinal fascia iliaca block in older-old patients for hip fractures: a retrospective study. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ELSEVIER) 2023; 73:711-717. [PMID: 34582902 PMCID: PMC10625135 DOI: 10.1016/j.bjane.2021.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 08/14/2021] [Accepted: 08/28/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pain management in hip fracture patients is of great importance for reducing postoperative morbidity and mortality. Multimodal techniques, including peripheral nerve blocks, are preferred for postoperative analgesia. Older-old hip fracture patients with high ASA scores are highly sensitive to the side effects of NSAIDs and opioids. Our aim was to investigate the effectiveness of the recently popularized Supra-Inguinal Fascia Iliaca Block (SIFIB) in this population. METHODS Forty-one ASA III...IV patients who underwent SIFIB...+...PCA (G-SIFIB) or PCA alone (Group Control: GC) after general anesthesia were evaluated retrospectively. In addition to 24-hour opioid consumption, Visual Analog Scale (VAS) scores, opioid-related side effects, block-related complications, and length of hospital stay were compared. RESULTS Twenty-two patients in G-SIFIB and 19 patients in GC were evaluated. The postoperative 24-hour opioid consumption was lower in G-SIFIB than in GC (p...<...0.001). There was a statistically significant reduction in VAS scores at the postoperative 1st, 3rd, and 6th hours at rest (p...<...0.001) and during movement (p...<...0.001 for the 1st and 3rd hours, and p...=...0.02 for the 6th hour) in G-SIFIB compared to GC. There was no difference in pain scores at the 12th and 24th hours postoperatively. While there was no difference between the groups in terms of other side effects, respiratory depression was significantly higher in GC than in G-SIFIB (p...=...0.01). CONCLUSION The SIFIB technique has a significant opioid-sparing effect and thus reduces opioid-related side effects in the first 24 hours after hip fracture surgery in older-old patients.
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Affiliation(s)
- Cagla Bali
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey.
| | - Ozlem Ozmete
- Baskent University School of Medicine, Anesthesiology and Reanimation Department, Adana, Turkey
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Azizoğlu M, Özdemir L, Bilgin M, Rumeli Ş. Awake femoral fracture surgery with suprainguinal fascia iliaca compartment and sciatic nerve blocks under dual antiplatelet therapy after coronary stent: A case report. J Orthop Sci 2023; 28:1436-1438. [PMID: 34140209 DOI: 10.1016/j.jos.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/28/2021] [Accepted: 04/11/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Mustafa Azizoğlu
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey.
| | - Levent Özdemir
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
| | - Merve Bilgin
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
| | - Şebnem Rumeli
- Mersin University Faculty of Medicine, Department of Anesthesiology and Reanimation, Mersin, Turkey
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Almeida CR. Deep fascia iliaca block combined with sacral plexus block for hip fracture surgery: A retrospective series of cases. Indian J Anaesth 2023; 67:560-563. [PMID: 37476439 PMCID: PMC10355351 DOI: 10.4103/ija.ija_540_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 03/28/2023] [Accepted: 04/08/2023] [Indexed: 07/22/2023] Open
Abstract
This case series describes a novel anaesthetic approach for hip fracture surgery using the deep fascia iliaca block combined with the sacral plexus block. This single-centre, retrospective study involved 15 patients aged 85 years or older and having significant cardiac disease. All the patients were managed with single-shot deep fascia iliaca block (22 or 25 ml of ropivacaine 0.5%) and sacral plexus block (12 or 15 ml of ropivacaine 0.5%, according to the patients' weight) after the administration of 50 μg of fentanyl intravenously. Intraoperatively, the patients were also administered light-to-moderate sedation. All patients presented a successful sensory block and a high level of haemodynamic stability (nil vasopressor consumption). In hip fracture surgery, low volume deep fascia iliaca block may be combined with sacral plexus block as primary anaesthetic technque, without any neuraxial technique or sympathetic blockade.
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Affiliation(s)
- Carlos R. Almeida
- Department of Anesthesiology, Tondela –Viseu Hospital Center, Viseu, Portugal
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Klimkiewicz J, Klimkiewicz A, Gutowski M, Rustecki B, Kochanowski D, Ryczek R, Lubas A. Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients. J Clin Med 2022; 11:jcm11133708. [PMID: 35806989 PMCID: PMC9267460 DOI: 10.3390/jcm11133708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/17/2022] [Accepted: 06/24/2022] [Indexed: 02/04/2023] Open
Abstract
Introduction. Intertrochanteric fracture (IF) is a common injury among the elderly. Due to significant comorbidities, anesthesia for IF repair may be challenging. The authors propose femoral nerve block together with a lateral femoral cutaneous nerve block and sedation as an anesthetic technique for most severe cases of IF with contraindications to spinal anesthesia. Methods. In total, 61 patients were enrolled prospectively in a study, 19 received general anesthesia (GA group), 22 spinal anesthesia (SA group), and 20 nerve blocks with sedation (PNB group). Results. Groups were comparable in terms of age, gender, independence, and several comorbidities: diabetes, obesity, underweight, cardiovascular, and cerebrovascular incidents in the past, dementia, chronic obstructive pulmonary disease, and frailty. Heart failure (p = 0.033), hemoglobin < 10 g/dL (p = 0.001) and eGFR < 30 mL/min (p = 0.039) were more frequent in PNB group. PNB group had higher American Society of Anesthesiologists (ASA) (p < 0.001), Nottingham Hip Fracture Score (NHFS) (p < 0.001), and Charlson Comorbidity Index (CCI) (p = 0.002) scales scores, and lower probability of 10-year survival according to CCI (p = 0.012). GA group had more frequent active malignancy (p = 0.041). GA and PNB groups had a higher frequency of hemostasis disorder (p < 0.001). Surgery was completed under the scheduled anesthesia technique. Survival, frequency of cardio and cerebrovascular incidents after surgery, loss of independence, and postoperative delirium were comparable between groups, as well as the length of postoperative stay. Conclusions. Surgical repair of intertrochanteric fracture with intramedullary nailing system among elderly, frail, and sick patients can be conducted under peripheral nerve block. FNB and LFCNB in the combination is a viable option for IT fracture repair.
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Affiliation(s)
- Jakub Klimkiewicz
- Department of Anesthesiology and Intensive Care, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (M.G.); (B.R.); (D.K.)
| | - Anna Klimkiewicz
- Department of Psychiatry, Medical University of Warsaw, 00-665 Warsaw, Poland;
| | - Mateusz Gutowski
- Department of Anesthesiology and Intensive Care, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (M.G.); (B.R.); (D.K.)
| | - Bartosz Rustecki
- Department of Anesthesiology and Intensive Care, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (M.G.); (B.R.); (D.K.)
| | - Dymitr Kochanowski
- Department of Anesthesiology and Intensive Care, Military Institute of Medicine, 04-141 Warsaw, Poland; (J.K.); (M.G.); (B.R.); (D.K.)
| | - Robert Ryczek
- Department of Cardiology, Military Institute of Medicine, 04-141 Warsaw, Poland;
| | - Arkadiusz Lubas
- Department of Internal Diseases Nephrology and Dialysis, Military Institute of Medicine, 04-141 Warsaw, Poland
- Correspondence: ; Tel.: +48-885-707-630
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Combination of a deep fascia iliaca block with ultra-low dose spinal anesthesia for hip fracture surgery. Can J Anaesth 2021; 69:402-404. [PMID: 34932178 DOI: 10.1007/s12630-021-02178-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/26/2021] [Accepted: 11/30/2021] [Indexed: 10/19/2022] Open
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Azizoğlu M, Rumeli Ş. Comparison of the suprainguinal fascia iliaca compartment block with continuous epidural analgesia in patients undergoing hip surgeries: a retrospective study. Braz J Anesthesiol 2021; 72:342-349. [PMID: 34324929 PMCID: PMC9373494 DOI: 10.1016/j.bjane.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 06/11/2021] [Accepted: 07/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background and objective Pain control is one of the major concerns after major hip surgeries. Suprainguinal fascia iliaca compartment block (S-FICB) is an alternative analgesic technique that can be considered as an effective and less invasive method than epidural analgesia (EA). In this retrospective study, we compared postoperative analgesic efficacy of single shot ultrasound guided S-FICB and EA after major hip surgery. Methods We retrospectively examined 150 patients who underwent major hip surgeries and who received S-FICB or EA. Seventy-two patients submitted to EA and 78 patients who received S-FICB were included and their medical records retrospectively reviewed. Morphine consumptions, VAS scores, and side effects were recorded. Patients under antiplatelet or anticoagulant theraphy were also registered. Morphine consumption and VAS scores were the primary endpoints, succes rate and complications were the secondary endpoints of our study. P-values less than 0.05 were considered statistically significant. Results Morphine consumption was lower at the emergence in the EA group but there was no statistically significant difference between the two groups according to total opioid consumption (0 [0-0] vs 0 [0-0]; p = 0.52). There was no difference between VAS scores in the first 18 hours. Hypotension was significantly higher in the EA group (9 vs 21; p = 0.04). Conclusion In conclusion, S-FICB can provide comparable analgesia with EA in the early postoperative period after hip surgery but VAS scores were found lower in the EA group than S-FICB group after 18th hour. Hypotension has occured more frequently in patients receiving EA.
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Affiliation(s)
- Mustafa Azizoğlu
- Mersin Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Mersin, Turkey.
| | - Şebnem Rumeli
- Mersin Üniversitesi Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Mersin, Turkey
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St Louis D, Iserson KV, Forget N. Fascia Iliaca Compartment Block Efficacy in Resource-poor Emergency Departments. Clin Pract Cases Emerg Med 2018; 2:286-290. [PMID: 30443607 PMCID: PMC6230372 DOI: 10.5811/cpcem.2018.9.39208] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 09/08/2018] [Accepted: 09/14/2018] [Indexed: 11/26/2022] Open
Abstract
Introduction Although the fascia iliaca compartment block (FICB) seems to be an ideal technique for femoral neck and shaft fractures occurring in resource-poor settings, it has been unclear how effective it is when used by emergency physicians (EP) with little training in the technique, using equipment, medications and methods that differ from those commonly available in developed countries. This series was designed to demonstrate that EPs in a resource-poor setting can provide effective analgesia for femur fractures with anatomic landmark-guided FICBs, clinician-compounded lidocaine-epinephrine (1:100,000), and a standard injection needle. Methods Over a three-month period, patients ≥12 years old presenting to the emergency department with hip or femur fractures and a Likert visual analogue scale >4 had an EP-administered FICB. EPs used a standard intramuscular needle and a lidocaine-epinephrine solution they compounded at the bedside and located the injection site using only anatomic landmarks. EPs evaluated the patient’s pain level at 30 minutes and at two hours post-FICB. We also reviewed articles since 2016 that describe the FICB. Results We enrolled a non-consecutive sample of 10 patients in the case series. Five had femoral neck (hip) fractures and five had femoral shaft fractures. All patients had a reduction in their pain levels after the FICB. On average, the block took effect about three minutes after injection. At 30 minutes all patients reported clinically meaningful pain reduction. The analgesic effect of the compounded agent lasted approximately 200 minutes. No adverse effects were reported. No published journal articles about FICB since 2016 were from resource-poor settings, and only one was from a developing country. Conclusion This series suggests that the FICB is effective even when performed with the minimal materials that are usually available in resource-poor settings. Methods such as this, which use simplified clinical tests and techniques applicable in resource-poor settings, can assist global emergency medicine (EM). We can assist global EM by similarly finding methods to simplify useful clinical tests and techniques that can be used in resource-poor settings.
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Affiliation(s)
- Daniel St Louis
- Georgetown Public Hospital, Department of Accident and Emergency Medicine, Georgetown, Guyana
| | - Kenneth V Iserson
- Georgetown Public Hospital, Department of Accident and Emergency Medicine, Georgetown, Guyana.,University of Arizona, Department of Emergency Medicine, Tucson, Arizona
| | - Nicolas Forget
- Vanderbilt University, Department of Emergency Medicine, Nashville, Tennessee
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Gremillet C, Jakobsson JG. Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study. F1000Res 2018; 7:1009. [PMID: 30210789 DOI: 10.12688/f1000research.15363.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Hip fractures affect 1.6 million patients yearly worldwide, often elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high and multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in elderly undergoing acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Methods: Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. Results: The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11,257, 82%), followed by general anaesthesia (GA; 2,190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. Conclusions: The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate in patients. Increasing age, ASA class and male gender increased the 30-day mortality.
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Affiliation(s)
- Caroline Gremillet
- Department of Anaesthesia & Intensive Care, Institution for Clinical Sciences, Danderyds University Hospital, Karolinska Institutet, Stockholm, 18288, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institution for Clinical Sciences, Danderyds University Hospital, Karolinska Institutet, Stockholm, 18288, Sweden
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Gremillet C, Jakobsson JG. Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study. F1000Res 2018; 7:1009. [PMID: 30210789 PMCID: PMC6107981 DOI: 10.12688/f1000research.15363.2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2018] [Indexed: 01/26/2023] Open
Abstract
Background: Hip fractures affect 1.6 million patients yearly worldwide, often elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high and multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in elderly undergoing acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Methods: Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. Results: The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11,257, 82%), followed by general anaesthesia (GA; 2,190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. Conclusions: The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate in patients. Increasing age, ASA class and male gender increased the 30-day mortality.
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Affiliation(s)
- Caroline Gremillet
- Department of Anaesthesia & Intensive Care, Institution for Clinical Sciences, Danderyds University Hospital, Karolinska Institutet, Stockholm, 18288, Sweden
| | - Jan G Jakobsson
- Department of Anaesthesia & Intensive Care, Institution for Clinical Sciences, Danderyds University Hospital, Karolinska Institutet, Stockholm, 18288, Sweden
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The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia. Reg Anesth Pain Med 2018; 43:211-216. [DOI: 10.1097/aap.0000000000000702] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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