JOCS
Journal of Comprehensive Surgery

The aim of the Comprehensive Surgery is to publish original research articles of the highest scientific and clinical value at the international level in all surgical fields. This journal is indexed by indices that are considered international scientific journal indices (DRJI, ESJI, OAJI, etc.). According to the current Associate Professorship criteria, it is within the scope of International Article 1-d. Each article published in this journal corresponds to 5 points.

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Original Article
Efficacy of combined lumbar plexus and parasacral sciatic nerve block in elderly patients undergoing hip fracture surgery: a retrospective analysis
Abstract
Aims: Hip fractures are a major cause of morbidity and mortality in the elderly population. Anesthesia management significantly affects outcomes in elderly patients. In recent years, peripheral nerve blocks acquired importance, especially in patients where subarachnoid blocks are contraindicated or in patients with severe pulmonary or cardiac diseases. This study aimed to retrospectively evaluate the efficacy of combined lumbar plexus block and parasacral sciatic nerve block in geriatric populations.
Methods: Data from patients over 70 years of age (ASA III) who underwent surgery for hip fracture and received combined lumbar plexus and parasacral sciatic nerve blocks between 2014 and 2024 were retrospectively analyzed. The efficacy of anesthesia, the need for intraoperative rescue anesthesia, and hemodynamic parameters were evaluated.
Results: The mean age of the 98 patients included in the study was 79.81 ± 8.94 years. Most patients had concomitant chronic diseases. A total of 19 (19.94%) patients were administered Fentanyl 50 mcg and Propofol 0.5 mg/kg for pain at the beginning of surgery, and none of the patients who received sedoanalgesia experienced severe respiratory distress or low oxygen saturation. Anesthesia and analgesia were effectively administered, and the need for intraoperative rescue anesthesia was low. Hemodynamic parameters remained stable.
Conclusion: Combined lumbar plexus and parasacral sciatic nerve block is an effective anesthetic method for hip surgery in elderly patients with comorbidities. This method reduces the need for general anesthesia, provides comprehensive analgesia, and maintains hemodynamic stability.

Keywords : Hip fracture, lumbar plexus block, parasacral sciatic nerve block, elderly patients, hip arthroplasty

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1. Parker M, Johansen A. Hip fracture. BMJ (Clinical research ed). 2006;333(7557):27-30. doi:10.1136/bmj.333.7557.27
2. Viganò M, Pennestrì F, Listorti E, Banfi G. Proximal hip fractures in71,920 elderly patients: incidence, epidemiology, mortality and costsfrom a retrospective observational study. BMC Public Health. 2023;23(1):1963. doi:10.1186/s12889-023-16776-4
3. Phang JK, Lim ZY, Yee WQ, Tan CYF, Kwan YH, Low LL. Post-surgeryinterventions for hip fracture: a systematic review of randomizedcontrolled trials. BMC Musculoskeletal Disorders. 2023;24(1):417.doi:10.1186/s12891-023-06512-9
4. Kaçmaz M, Turhan ZY. Spinal anesthesia versus combined sciaticnerve/lumbar plexus nerve block in elderly patients undergoing totalhip arthroplasty: a retrospective study. Ann Saudi Med. 2022;42(3):174-180. doi:doi:10.5144/0256-4947.2022.174
5. Neuman MD, Feng R, Carson JL, et al. Spinal anesthesia or generalanesthesia for hip surgery in older adults. New England J Med. 2021;385(22):2025-2035. doi:10.1056/NEJMoa2113514
6. Karmakar MK. Lumbar paravertebral sonography and considerationsfor ultrasound-guided lumbar plexus block. Pain. 2023.
7. Stevens Robert D, Van Gessel E, Flory N, Fournier R, Gamulin Z.Lumbar plexus block reduces pain and blood loss associated withtotal hip arthroplasty. Anesthesiology. 2000;93(1):115-121. doi:10.1097/00000542-200007000-00021
8. Karademir G, Bilgin Y, Erşen A, et al. Hip fractures in patients olderthan 75 years old: retrospective analysis for prognostic factors. Int JSurg. 2015;24(PA):101-104. doi:10.1016/j.ijsu.2015.11.009
9. Zhang J, Li Y, Sun X, Ren W. Effects of Lumbar plexus block combinedwith infiltration anesthesia on anesthesia comfort scores and stressresponses in elderly patients undergoing hip replacement. Dis Mark.2022;2022(1):8692966. doi:https://doi.org/10.1155/2022/8692966
10. Sharma H, Mitra S, Singh J, Gupta S, Garg S. A randomized studycomparing the efficacy of ultrasound guided lumbar plexus block andepidural anesthesia for postoperative analgesia in patients undergoingtotal hip replacement. Asian J Anesthesiol. 2020;58(4):131-137.doi:10.6859/aja.202012_58(4).0003
11. Ahamed ZA, Sreejit MS. Lumbar plexus block as an effective alternativeto subarachnoid block for intertrochanteric hip fracture surgeries inthe elderly. Anesth Essays Res. 2019;13(2):264-268.
12. Rubin DI. Brachial and lumbosacral plexopathies: a review. ClinNeurophysiol Prac. 2020;5:173-193. doi:https://doi.org/10.1016/j.cnp.2020.07.005
13. Oliver-Fornies P, Ortega Lahuerta JP, Gomez Gomez R, GonzaloPellicer I, Herranz Andres P, Sancho-Saldana A. Postoperativeneurological complications after brachial plexus block: a retrospectivestudy conducted at a teaching hospital. J Anesth. 2021/12/01 2021;35(6):844-853. doi:10.1007/s00540-021-02989-7
14. Allegri M, Bugada D, Grossi P, et al. Italian registry of complicationsassociated with regional anesthesia (RICALOR). An incidence analysisfrom a prospective clinical survey. Minerva Anestesiol. 2016;82(4):392-402.
15. Memtsoudis SG, Cozowicz C, Bekeris J, et al. Anaesthetic care ofpatients undergoing primary hip and knee arthroplasty: consensusrecommendations from the International Consensus on Anaesthesia-Related Outcomes after Surgery Group (ICAROS) based on a systematicreview and meta-analysis. Br J Anaesth. 2019;123(3):269-287. doi:10.1016/j.bja.2019.05.042
16. Choi EJ, Choi YJ, Lee SW, et al. Effect of anesthetic method on incidenceof delirium after total hip replacement arthroplasty in South Korea: apopulation-based study using National Health Insurance claims data.Korean J Anesthesiol. 2020;73(1):36-43. doi:10.4097/kja.19091
17. Meyhoff CS, Hesselbjerg L, Koscielniak-Nielsen Z, Rasmussen LS.Biphasic cardiac output changes during onset of spinal anaesthesia inelderly patients. Eur J Anaesthesiol. 2007;24(9):770-775. doi:10.1017/S0265021507000427
18. Ferré F, Martin C, Bosch L, Kurrek M, Lairez O, Minville V. Controlof spinal anesthesia-induced hypotension in adults. Local Reg Anesth.2020;13:39-46. doi:10.2147/LRA.S240753
19. Gamli M, Sacan O, Baskan S, Ozciftci S, Gogus N. Combined lumbarplexus and sciatic nerve block for hip fracture surgery in a patient withsevere aortic stenosis. J Anesth. 2011;25(5):784-785. doi:10.1007/s00540-011-1179-3
20. AlMutiri WA, AlMajed E, Alneghaimshi MM, et al. Efficacy ofcontinuous lumbar plexus blockade in managing post-operative painafter hip or femur orthopedic surgeries: a systematic review and meta-analysis. J Cli Med. 2024;13(11):3194. doi:10.3390/jcm13113194
Article available in :
Volume 2, Issue 3, 2024
Page : 56-59
https://doi.org/10.51271/JOCS-0036
Article Information
Received : 01 Ağu 2024
Accepted : 23 Ağu 2024
Published : 27 Ağu 2024
Corresponding Author :

Alparslan Koç: Department of Anesthesiology and Reanimation, Erzincan Binali Yıldırım University Mengucek Gazi Training and Research Hospital, Erzincan, Turkiye

[email protected]
Citation : Akyol F, Koç A, Arı MA, Somunkıran M. Efficacy of combined lumbar plexus and parasacral sciatic nerve block in elderly patients undergoing hip fracture surgery: a retrospective analysis. J Compr Surg. 2024;2(3):56-59.

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