engleski

Ultrasound guided quadri block for ostheosynthesis of subtrochanteric femoral fracture

A 86-year-old patient, 170 cm high, 73 kg weight, fell down in his apartment. He complained of severe pain and in his hip and immobility. Patient had severe aortic stenosis, low left ventricular function (EF 35%), pulmonary hypertension, incipient pneumonia, left -sided fibrothorax, chronic renal insufficiency. Four years ago he underwent cardiac surgery, had four aortocoronary bypasses and simultaneously had carotid revascularization. Two years ago he had spinal cord stroke with consequent left -sided hemiparesis. His laboratory data were: Hgb 111, Htc 0.31, urea 12.4, creatinin 189, PV 0.6, PLT 116. BP was 86/50 mmHg, HR 103/min, SpO2 89%. Because of his status (ASA IV), our goal was to avoid mechanical ventilation, optimize hemodynamic stability and ensure good postoperative analgesia. We used ultrasound- guided block of four nerves with high frequency linear probe and in- plane needle guiding technique. With standard approach on femoral nerve we used 15 ml, on schiatic transgluteal approach 18 ml, on lateral femoral cutaneous nerve between sartorius and tensor fasciae lata muscle 7 ml and on proximal block of n. obturatorius 5 ml of local anesthetic. Surgery started 15 min after performing the block. Total of 45ml local anesthetic mixture (0.5% levobupivacaine with 8mg dexamethasone) was used without additional sedation. Patient was breathing spontaneously and remained hemodynamically stable throughout the surgery. Motor block lasted for 18 hours and sensory block lasted for 24 hours after the surgery. Patient had excellent postoperative analgesia and did not require additional analgesia during the whole postoperative period.

Ultrasound; quadri block; femoral fracture

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