Hip hemiarthroplasty using major lower limb nerve blocks: A preliminary report of a case series

Abstract

Background:Major lower limb nerve blocks are relatively safe techniques. However, their efficacy for hip hemiarthroplasty is unknown. The objective of this study was to determine the effectiveness of combined femoral, sciatic, obturator and lateral femoral cutaneous (LFC) nerve blocks in providing adequate anesthesia for hip hemiarthroplasty.Materials and Methods:A total of 20 patients with fracture neck femur; who underwent hip hemiarthroplasty, participated in this observational study. In the induction room, all patients received ultrasound-guided femoral, proximal obturator, LFC and parasacral sciatic nerve blocks in addition to local infiltration at the proximal site of the skin incision. Anesthesia was considered to be adequate only if the surgery was completed without any requirement for opioid administration.Results:All patients (100% [95% confidence interval, 86-100%]) had adequate anesthesia. Seventeen patients (85% [95% confidence interval, 63-96%] had mild discomfort during the reduction of the prosthetic femur head back into the hip socket; however, no supplementary analgesics were required.Conclusion:The combined femoral, sciatic, obturator and LFC nerve blocks in addition to local infiltration at the proximal site of skin incision could provide adequate anesthesia for hip hemiarthroplasty. Light sedation before reduction of the prosthetic femur head back into the hip socket is advisable.

Sciatic obturator femoral technique versus spinal anaesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator. A randomised trial

“…Performance of multiple nerve blocks requires large doses of bupivacaine so we have to be alert about the risk of LA toxicity which causes convulsions at plasma level 4 μg/ml. For this reason, enantiomer LA with lower concentration has to be used [15] and we found that it theoretically provides adequate anaesthesia for this type of surgical procedure. Some studies aimed to reducing the number of nerves blocked to decrease the risk of toxicity but it may cause inadequate anaesthesia to perform the required surgical procedures [16].…”

Sciatic obturator femoral technique versus spinal anesthesia in patients undergoing surgery for fixation of open tibial fractures using Ilizarov external fixator: A randomised trial

“…Performance of multiple nerve blocks requires large doses of bupivacaine so we have to be alert about the risk of LA toxicity which causes convulsions at plasma level 4 µg/ml. For this reason, enantiomer LA with lower concentration has to be used [15] and we found that it theoretically provides adequate anaesthesia for this type of surgical procedure.…”

Surgical anesthesia with a combination of T12 paravertebral block and lumbar plexus, sacral plexus block for hip replacement in ankylosing spondylitis: CARE-compliant 4 case reports

“…Because all other branches of the sacral plexus can be blocked, it is more effective for hip surgery when combined with lumbar plexus block. However, due to the lack of reliable sensory block in dermatome T12 and L1 [ 25 ], a combination of lumbar plexus and sacral plexus block failed to provide consistent surgical anesthesia for hip surgery [ 6 , 8 , 26 , 27 ]. Several techniques have been introduced to overcome the limitation, such as large dosage of propofol and opioids [ 8 ], infiltration at incision [ 4 ] and iliac crest point block [ 9 ].…”