Shamrock Lumbar Plexus Block for Hip Hemiarthroplasty in a High Risk Elderly Patient with Hip Fracture

Abstract

Hip fractures in the geriatric population are associated with high morbidity and mortality rate. Early surgical fixation is of major importance, as it is one of the factors that contribute to patient optimization. However, these patients usually present a high burden of comorbidities, including aortic stenosis that could affect their treatment. Despite major advances in anesthetic and surgical techniques, severe aortic stenosis remains an independent, important risk factor for patients undergoing anesthesia for noncardiac surgery. In these patients, general and/or neuraxial anesthesia should be avoided; peripheral nerve blockade is a viable option. This article presents a 96-year-old hip fracture patient with severe aortic stenosis and aspiration pneumonia that successfully underwent hip hemiarthroplasty under peripheral nerve blockade as sole anesthesia.

Peripheral Nerve Blocks in Geriatric Orthopedic Anesthesia for Hip Fractures: Unveiling Economic and Clinical Dimensions

“…PNBs offer safe and effective alternatives to spinal anesthesia for surgeries like total knee and hip arthroplasty, potentially avoiding associated side effects and complications [49] . The consideration that single-injection blocks may reduce drug costs adds to the promising outlook for better patient outcomes and potentially reduced overall costs [64].…”

“…In the elderly, where hip fractures often present significant risks, research also demonstrates the success of peripheral nerve blocks, even in highrisk patients. A 96-year-old with severe aortic stenosis underwent successful hip surgery using this method [49].…”