Peripheral nerve blocks with sedation using propofol and alfentanil target-controlled infusion for hip fracture surgery: a review of 6 years in use

Johnston, David; Stafford, Michael A.; McKinney, M. S.; Deyermond, R.; Dane, Kathryn

doi:10.1016/j.jclinane.2015.10.012

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…We merely sorted into three main techniques: neuraxial, general and combined anaesthesia. Peripheral blocks and light anaesthesia/sedation may indeed be an option 10, 11 . We have not considered this surgical technique in the present study.…”

Section: Discussionmentioning

confidence: 99%

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Gremillet

Jakobsson

2018

F1000Res

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Hip fractures yearly affect 1.6 million patients worldwide, often the elderly with complex comorbidity. Mortality following surgery for acute hip fracture is high. The high mortality rate is multifactorial; high age, comorbidities and complication/deterioration in health following surgery. Whether the anaesthesia technique affects the 30-day mortality rate has been studied widely without reaching a consensus. The primary aim of this study was to determine anaesthetic techniques used in Sweden and their impact on the 30-day mortality rate in the elderly, who underwent acute hip fracture surgery. Other aims were to study the impact of age, gender, ASA class, fracture type and delay in surgery on the 30-day mortality rate. Data from 13,649 patients ≥50 years old who had undergone acute hip fracture surgery and been reported to Swedish perioperative register (SPOR) between 2016 and 2017 were analysed. The most commonly used anaesthetic technique was neuraxial anaesthesia (NA; 11257, 82%), followed by general anaesthesia (GA; 2190, 16%) and combined general and neuraxial anaesthesia (CA; 202, 1.5%) out of the 13,649 studied. The 30-day mortality rate was 7.7% for the entire cohort; GA 7.8%, NA 7.7% and CA 7.4%. Mortality was higher in elderly patients, those with a high ASA class, pertrochanteric fracture and males. The present study showed that NA is by far the most common anaesthetic technique for acute hip fracture surgery in Sweden. However, the anaesthetic technique used during this type of surgery had no impact on the 30-day mortality rate of patients. Increasing age, ASA class and male gender increased the 30-day mortality.

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Section: Discussionmentioning

confidence: 99%

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Gremillet

Jakobsson

2018

F1000Res

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“…7 Johnston et al reported performing femoral nerve plus lateral femoral cutaneous nerve blocks in addition to sedation with propofol and alfentanil for either dynamic hip screws or hip hemiarthroplasties. 2 They had a failure rate of 7.2% with this technique, requiring conversion to general anesthesia. 8 QL blocks have been used for analgesia after total hip replacement; thus, we added the QL block to allow us to perform the case without additional local anesthetic infiltration or narcotics.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10] Additionally, a revision of a total hip replacement is more invasive than a cephalomedullary nail, dynamic hip screw, or hemiarthroplasty, justifying the addition of the QL block to the FI block. 2…”

Section: Discussionmentioning

confidence: 99%

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Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block

Haan

Hernandez

Dean

et al. 2019

Baylor University Medical Center Proceedings

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We present a case in which surgical anesthesia was provided for revision of earlier total hip arthroplasty with quadratus lumborum and fascia iliaca blocks. We believe that this case is the first to be reported using this technique for this procedure. Our patient was a high-risk candidate for general and neuraxial anesthesia because of significant cardiac dysfunction and therapeutic anticoagulation.

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“…Although intravenous sedation was provided throughout the procedure, the overall amounts of anesthetic administered are much lower than would be required for a deep GA with airway assistance. One other study in the literature used a peripheral nerve block technique involving a blockade of both the femoral and lateral femoral cutaneous nerves in conjunction with mild sedation for the surgical treatment of hip fractures [9]. The authors reported a 7.2% conversion rate to GA due to inadequate analgesia provided by their block.…”

Section: Discussionmentioning

confidence: 99%

The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study

Ruzbarsky

Gausden

Goldwyn

et al. 2018

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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In this series of patients, we demonstrate that a fascia iliaca block can reliably be utilized as the primary anesthetic for patients undergoing surgical fixation of intertrochanteric hip fractures, with an acceptable perioperative complication profile. Although concomitant sedation was provided with the block, this anesthesia strategy has the potential to reduce preoperative delays and minimize the overall burden of sedative and anesthetic medications in a geriatric population. These initial findings may serve as a basis for future, higher-quality prospective and comparative studies.

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Peripheral nerve blocks with sedation using propofol and alfentanil target-controlled infusion for hip fracture surgery: a review of 6 years in use

Cited by 18 publications

References 22 publications

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Acute hip fracture surgery anaesthetic technique and 30-day mortality in Sweden 2016 and 2017: A retrospective register study

Surgical anesthesia for revision total hip arthroplasty with quadratus lumborum and fascia iliaca block

The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study

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