Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly

Abstract

Plain bupivacaine spinal anesthesia and combined lumbar/sacral plexus block provided adequate anesthesia for repair of hip fracture in the elderly. Hypotension was induced by both the combined peripheral nerve block and plain bupivacaine spinal anesthesia in aged patients; hypotension was found to be longer lasting after spinal anesthesia and of a larger magnitude in patients over 85 years of age.

Combined Lumbar-Sacral Plexus Block in High Surgical Risk Geriatric Patients undergoing Early Hip Fracture Surgery

“…General anaesthetic options as general anaesthesia and neuraxial anaesthesia, that would result in higher complications due to - significant physiologic changes following those techniques with delay in post-operative recovery, might not be appropriate in this particular group of patients 14-16 . Therefore, peripheral nerve blockade with CLSB, which has a specific-site effect on only one leg and causes a lesser physiologic disturbance with a comparable anaesthetic effect, is possibly a more suitable alternative.…”

“…Firstly, CLSB has been proven as a safe and effective procedure in perioperative pain control as standard anesthetic method 14-16,22 . This is because the effect of CLSB could cover all innervated area of the hip and its joint capsule - supplied by lumbar plexus and branches of sciatic nerve 23 .…”

“…This is because the effect of CLSB could cover all innervated area of the hip and its joint capsule - supplied by lumbar plexus and branches of sciatic nerve 23 . Secondly, compared with NA, CLSB provided better hemodynamic control and avoidance of potential serious complications such as spinal or epidural hematoma, severe and prolonged intraoperative hypotension, and side effect from high opioid dosage 13,14 . Lastly, highly specific nerve blockade with CLSB, either single shot technique or continuous infusion via lumbar catheter, offered an immediate postoperative ambulation with high patient satisfaction.…”

“…Recently, peripheral anaesthesia (PA), which block one or more peripheral nerves that supply the surgical field in the operated limb, has been proven to be an effective method for lower limb surgery 13 . Recently also, application of combined lumber and sacral plexus block (CLSB), has been introduced as a newer PA method in HF surgery with a comparable efficacy to NA 14 . Moreover, CLSB also demonstrated many advantages over NA, as better hemodynamic control in elderly patients and avoidance of the risk of NA-related complications 14 .…”

“…Recently also, application of combined lumber and sacral plexus block (CLSB), has been introduced as a newer PA method in HF surgery with a comparable efficacy to NA 14 . Moreover, CLSB also demonstrated many advantages over NA, as better hemodynamic control in elderly patients and avoidance of the risk of NA-related complications 14 . However, there were only a few case reports related to using combined lumbar and sacral plexus block (CLSB) in high-risk geriatric patients 15,16 .…”