Why the study?
The hemodynamic effects of subarachnoid block in geriatric patients with proximal femoral fractures and cardiac comorbidities are potentially detrimental, necessitating evaluation of alternative regional anesthesia techniques.
Does lumbosacral plexus block compared to segmental epidural anesthesia affect hemodynamic variables in patients undergoing proximal femoral nailing for proximal femoral fractures?
Cohort (n=29)
Does lumbosacral plexus block compared to segmental epidural anesthesia affect hemodynamic variables in patients undergoing proximal femoral nailing for proximal femoral fractures?
Both segmental epidural and lumbosacral plexus blocks provide steady hemodynamics during proximal femoral nailing, though they exhibit different relationships between cardiac output and mean arterial pressure.
Lumbosacral plexus block was associated with a steeper MAP-SV relationship than epidural; hypothesis-generating for anesthesia choice in proximal femoral nailing.
Background and objectives Neuraxial anesthesia, particularly the subarachnoid block (SAB) or spinal anesthesia, is a viable option utilized for the surgical management of proximal femoral fractures (PFF) in the geriatric population. The hemodynamic effects of SAB could be detrimental in the geriatric population, especially with cardiac comorbidities. A segmental epidural or lumbosacral plexus block (LSPB) is particularly safe for this cohort while undergoing proximal femoral nail (PFN) surgery. We decided to monitor variations in cardiac output (CO) and stroke volume (SV) in a cohort of patients who were undergoing proximal femoral nailing for PFFs. The FloTrac/Vigileo™ System was employed to monitor hemodynamic variables continuously. Methods This prospective, observational study included 29 patients with PFFs. Heart rate, CO, SV, and mean arterial pressure (MAP) were continuously monitored from the commencement of regional anesthesia (segmental epidural or LSPB) to the conclusion of the surgical procedure. Before regional anesthesia techniques, each patient was administered a mini-fluid challenge. Results Eleven patients were recruited in the epidural group, and 18 patients in the LSPB group. Compared to the epidural group, for each unit increase in SV in the LSPB group, the rate of increase in MAP was higher by 0.13 (p<0.001). Compared to the epidural group, for each unit increase in CO in the LSPB group, the rate of increase in MAP was higher by 2.78 (p<0.001). Compared to the epidural group, for each minute passed under the LSPB group, the rate of increase in CO was lower by 2.18 (p<0.001). Compared to the epidural group, for each minute passed under the LSPB group, the rate of increase in SV was lower by 0.05 (p<0.001). In four patients in whom LSPB was administered, noradrenaline and vasopressors were given, while six patients in the epidural group received inotropes and vasopressors. Conclusions In patients having PFN for PFFs, regional anesthesia in the form of a segmental epidural or lumbosacral plexus provides steady hemodynamics during the perioperative phase. Furthermore, maintaining proper fluid balance can meet a fluid challenge even in high-risk populations.
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Diwan et al. (2025) conducted a cohort in Proximal femoral fractures (n=29). Lumbosacral plexus block vs. Segmental epidural was evaluated on Rate of increase in mean arterial pressure per unit increase in stroke volume (higher by 0.13, p=<0.001).
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