Key result
Fascia iliaca block plus monitored anesthesia provides stable hemodynamics during hip surgery in two high-risk patients.
Why the study?
Major hip surgery usually requires neuraxial or general anesthesia, but high-risk geriatric patients may have contraindications to both approaches.
Does combined fascia iliaca compartment block and monitored anesthesia care provide satisfactory analgesia and stable hemodynamics for hip surgery in high-risk geriatric patients?
Case Report (n=2)
No
Does combined fascia iliaca compartment block and monitored anesthesia care provide satisfactory analgesia and stable hemodynamics for hip surgery in high-risk geriatric patients?
Combined fascia iliaca compartment block and monitored anesthesia care may be a feasible and safe alternative to general or neuraxial anesthesia for high-risk geriatric patients undergoing hip fracture surgery.
May support regional-MAC anesthesia in select high-risk geriatric hip cases; hypothesis-generating and requires prospective trials before adoption.
BACKGROUND: Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief. CASE SUMMARY: This report established that hip surgical procedures can be performed with a fascia iliaca compartment block (FICB) and monitored anesthesia care (MAC) while avoiding neuraxial or general anesthesia. This was a preliminary experience with two geriatric patients with hip fracture, American Society of Anesthesiologists status III, and with many comorbidities. Neither patient could be operated on within 48 h after admission. Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications. Hence, we chose nerve block combined with a small amount of sedation. Intraoperative analgesia was provided by single-injection ultrasound-guided FICB. Light intravenous sedation was added. Surgical exposure was satisfactory, and neither patient complained of any symptoms during the procedure. CONCLUSION: This report showed that hip surgery for geriatric patients can be performed with FICB and MAC, although complications and contraindications are common. The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.
No takes yet. Share an insight, caveat, or question.
Zhan et al. (2021) conducted a case report in Hip fracture (n=2). Combined fascia iliaca compartment block (FICB) and monitored anesthesia care (MAC) was evaluated on Satisfactory surgical anesthesia and stable hemodynamics. Combined fascia iliaca compartment block and monitored anesthesia care provided satisfactory surgical anesthesia and stable hemodynamics for hip surgery in two geriatric patients with severe comorbidities.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: