Monitored Anesthesia Care and Soft-Tissue Infiltration With Local Anesthesia: An Anesthetic Option for High-Risk Patients With Hip Fractures

Monitored Anesthesia Care and Soft-Tissue Infiltration With Local Anesthesia for Short Cephalomedullary Nailing in Medically Complex Patients: A Technique Guide

“…Hip fractures occur commonly in the medically complex patient population, yet there is limited literature and recommendations on performing surgical interventions on these patients using options that do not involve general or neuraxial anesthesia. The senior author has published a case-control series comparing the MAC-STILA technique for hip fracture repair to a matched cohort of spinal and general anesthesia patients and demonstrated improved maintenance of intraoperative physiologic parameters with MAC-STILA and similar postoperative pain control compared to spinal anesthesia up to 72 hours postoperatively [ 10 ]. This Technical Note article more clearly elucidates the technique for reproducibility at other institutions.…”

“…Surgery under local anesthesia only with or without monitored anesthesia sedation has been well described and successful in distal extremity surgery [ 8 , 9 ]. Monitored Anesthesia Care and Soft-Tissue Infiltration of Local Anesthetic (MAC-STILA) has been used at our institution for medically complex patients requiring percutaneous hip fracture fixation to avoid complications associated with general or neuraxial anesthesia [ 10 ].…”

Monitored Anesthesia Care and Soft Tissue Infiltration with Local Anesthesia: An Anesthetic Option for High-Risk Patients with Hip Fractures

“…It is also indicated for all hip fractures that can be fixed with a sliding hip screw (31A1) or cannulated screws (31B). 5…”

“…The protocol has comparable postoperative analgesic affects when compared with spinal anesthesia without differences in complication rates, mortality, or hospital quality measures when compared with both spinal and general anesthesia. 5…”

“…The MAC-STILA protocol has been demonstrated to be a safe and effective anesthetic option for intramedullary hip fracture fixation of intertrochanteric hip fractures with short cephalomedullary nails. 5 Furthermore, it has been associated with improved maintenance of normal intraoperative physiologic parameters when compared with general and spinal anesthesia. The protocol has comparable postoperative analgesic affects when compared with spinal anesthesia without differences in complication rates, mortality, or hospital quality measures when compared with both spinal and general anesthesia.…”