[Combined lumbar plexus-sciatic nerve block in the emergency surgery for pertrochanteric fracture: an alternative technique in patients at high risk of anaesthetic complications]

Ismail Aissa, Loukman El Wartiti, Najib Bouhaba, Said Khallikane, Mohamed Moutaoukil, Noureddine Kartite, Abdelghafour Elkoundi, Aziz Benakrout, Abdellatif Chlouchi, Anas Elbouti, Hamza Najout, Ali Grine, Reda Touab, Abderrahim Zaizi, Jalal Youssef, Hicham Bakkali, Hicham Balkhi, Mustapha Bensghir, Ismail Aissa, Loukman El Wartiti, Najib Bouhaba, Said Khallikane, Mohamed Moutaoukil, Noureddine Kartite, Abdelghafour Elkoundi, Aziz Benakrout, Abdellatif Chlouchi, Anas Elbouti, Hamza Najout, Ali Grine, Reda Touab, Abderrahim Zaizi, Jalal Youssef, Hicham Bakkali, Hicham Balkhi, Mustapha Bensghir

Abstract

Introduction: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures.

Methods: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications.

Results: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery.

Conclusion: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia.

Keywords: Lumbar plexus-sciatic nerve block; emergency surgery; patients at high risk of anaesthetic complications; pertrochanteric femoral fractures.

Conflict of interest statement

Les auteurs ne déclarent aucun conflit intérêts.

Copyright: Ismail Aissa et al.

Figures

Figure 1
Figure 1
évolution des paramètres hémodynamiques et respiratoires periopératoires; (PAM: pression artérielle moyenne, FC: fréquence cardiaque, SPO2: saturation pulsée en oxygène, Ad: admission au bloc opératoire, Sed: sédation)

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