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. 2022 Jun 27;11(13):3708.
doi: 10.3390/jcm11133708.

Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients

Jakub Klimkiewicz  1 , Anna Klimkiewicz  2 , Mateusz Gutowski  1 , Bartosz Rustecki  1 , Dymitr Kochanowski  1 , Robert Ryczek  3 , Arkadiusz Lubas  4
Affiliations

Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients

Jakub Klimkiewicz et al. J Clin Med. .

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.

Keywords: femoral nerve block; intertrochanteric fracture; lateral femoral cutaneous nerve block.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

    1. Parker M., Johansen A. Hip fracture. BMJ. 2006;333:27–30. doi: 10.1136/bmj.333.7557.27. - DOI - PMC - PubMed
    1. Li J., Dai F., Chang D., Harmon E., Ibe I., Sukumar N., Halaszynski T.M., Rubin L.E., O’Connor M.I. A Practical Analgesia Approach to Fragility Hip Fracture: A Single-Center, Retrospective, Cohort Study on Femoral Nerve Block. J. Orthop. Trauma. 2019;33:175–179. doi: 10.1097/BOT.0000000000001391. - DOI - PubMed
    1. Amin N.H., West J.A., Farmer T., Basmajian H.G. Nerve Blocks in the Geriatric Patient With Hip Fracture: A Review of the Current Literature and Relevant Neuroanatomy. Geriatr. Orthop. Surg. Rehabil. 2017;8:268–275. doi: 10.1177/2151458517734046. - DOI - PMC - PubMed
    1. Hirose J., Mizuta H., Ide J., Nakamura E., Takada K. E-PASS for predicting postoperative risk with hip fracture: A multicenter study. Clin. Orthop. Relat. Res. 2008;466:2833–2841. doi: 10.1007/s11999-008-0377-2. - DOI - PMC - PubMed
    1. Burgos E., Díez R., Muñoz L., Del Valle S.G., Gómez-Arnau J.I., Fernández-Guisasola J. Predictive value of six risk scores for outcome after surgical repair of hip fracture in elderly patients. Acta Anaesthesiol. Scand. 2008;52:125–131. doi: 10.1111/j.1399-6576.2007.01473.x. - DOI - PubMed