Early surgical intervention for hip fractures in the elderly has proven efficacious. However, surgical delays commonly occur in this patient population due to comorbid conditions that put these patients at a high risk for hypotension-related complications of general or neuraxial anesthesia or anticoagulants that delay the safe use of neuraxial anesthesia.
The questions/purposes of this study are (1) to investigate if a fascia iliaca block in conjunction with light to moderate sedation could provide adequate analgesia throughout open surgery for intertrochanteric hip fractures (AO/OTA 31-1) without requiring conversion to general anesthesia with airway support and (2) to assess its perioperative complication profile.
A retrospective chart review was conducted to identify patients with intertrochanteric hip fractures who underwent anesthesia with a fascia iliaca block over a 1.5-year period.
In the six patients identified, there were no intraoperative conversions to general anesthesia requiring airway support. Additionally, there were no intraoperative complications, no mortalities within 30 days, 2 patients on anticoagulation who required a blood transfusion, and a single patient who developed a postoperative hospital-acquired pneumonia that resolved with an antibiotic course.
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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This protocol was IRB approved on 2/22/2016 at the New York Presbyterian Queens.
Conflict of Interest
Joseph J. Ruzbarsky, MD; Isaac P. Lowenwirt, MD; Elan M. Goldwyn, MD; and Vitaly Kotlyar, MD, have declared that they have no conflict of interest. Elizabeth B. Gausden, MD, has received funding from the Samuel and May Rudin Foundation.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5).
Informed consent was waived from all patients for being included in the study.
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Level of Evidence: Case series: Level IV
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Ruzbarsky, J.J., Gausden, E.B., Goldwyn, E.M. et al. The Fascia Iliaca Block as the Primary Intraoperative Anesthesia for Hip Fracture Surgery: A Preliminary Study. HSS Jrnl 14, 77–82 (2018). https://doi.org/10.1007/s11420-017-9582-4
- intertrochanteric hip fracture surgery
- regional anesthesia
- fascia iliaca block
- high-risk surgical candidates