pain-management-2018-scientifictracks

31 / 31

Page 74
conferenceseries.com
Volume 7 Journal of Pain & Relief
ISSN: 2167-0846 Pain Management 2018
October 11-12, 2018
October 11-12, 2018 | Zurich, Switzerland
7th International Conference and Exhibition on
Pain Research and Management
Combination of lumbar plexus with parasacral sciatic nerve block for hip fracture in elderly patient
with heart disease and chronic lung disease
Nunez-Diquez Juan Carlos and Nava Danilo
Mendez Gimón Clinic, Venezuela
The incidence of hip fractures has been increasing in the elderly. Lumbar plexus block (LPB) is an advanced nerve block
technique with known advantages for the management of these patients. Because the placement of the needle is in the deep
muscles, the potential for systemic toxicity is greater. Care should be taken when selecting the type, volume, and concentration
of local anesthetic. The LPB provides anesthesia or analgesia to the entire distribution of the LP, including the anterolateral
and medial thigh. When combined with a sciatic nerve block, anesthesia of the entire leg can be achieved. Because of the
complexity of the technique, the benefits of LPB should be always being weighed against the risks. This is a case of 85 y/o elderly
female patient, with a right femur fracture requested for hip arthroplasty. The patient has a diagnosed of chronic ischemic
heart disease and chronic obstructive pulmonary disease, ASA III-E. The laboratory values were satisfactory. It was decided
to perform the anesthetic technique based on the LPB accompanied by Sciatic Nerve Block at the Para Sacral level. We use
ASA-Standard monitoring, sedation was administered with I.V Remifentanyl 0.001 mcg/Kg/min, and oxygen with facemask.
The patient was placed in the left lateral decubitus position. Iliac crest, spinous processes (midline), a standard regional
anesthesia tray is prepared with sterile towels and gauze. After aseptic and antisepsis procedure the skin and paravertebral
muscles are anesthetized by infiltrating local anesthetic subcutaneously at site of needle insertion. The respective nerve blocks
were performed using a 10 mm sterile needle connected to a peripheral nerve stimulator. Visible or palpable twitches of the
quadriceps muscle at 1mAwere sought. Anesthetic mixture consists of 2%Lidocaine, 5% bupivacaine and 4mg dexamethasone
per 20 ml. The orthopedic procedure was carried out without complications and the patient remained stable and comfortable.
Recent Publications:
1. Dyer S, Crotty M and Fairhall N A (2016) Critical review of the long-term disability outcomes following hip fracture.
BMC Geriatrics 16:158.
2. Nirav A, West J, Farmer T and Basmajian H (2017) Nerve blocks in the geriatric patient with hip fracture: a review of the
current literature and relevant neuroanatomy. SAGE 8(4):268-275.
3. Mitragotri M V, Agrawal P I, Kulkarni V V, Adke N S and Ladhad D A (2017) The comparative study of two techniques
of lumbar plexus block by anterior and posterior approach for lower limb surgery. Indian Journal of Pain 31:146-51.
4. Lu et al. (2018) Comparison of lumbar plexus block using the short axis in-plane method at the plane of the transverse
process and at the articular process: a randomized controlled trial. BMC Anesthesiology 18(1):17.
5. Sultan WA, Ibrahim E S and El-Tahawy M S (2018) Continuous psoas sciatic blockade for total knee arthroplasty. Saudi
Journal of Anaesthesia 12:426-32.
Nunez-Diquez Juan Carlos et al., J Pain Relief 2018, Volume 7
DOI: 10.4172/2167-0846-C1-020