Published online Sep 26, 2021. doi: 10.12998/wjcc.v9.i27.8268
Peer-review started: June 13, 2021
First decision: June 25, 2021
Revised: July 6, 2021
Accepted: July 27, 2021
Article in press: July 27, 2021
Published online: September 26, 2021
Major hip surgery usually requires neuraxial or general anesthesia with tracheal intubation and may be supplemented with a nerve block to provide intraoperative and postoperative pain relief.
This report established that hip surgical procedures can be performed with a fascia iliaca compartment block (FICB) and monitored anesthesia care (MAC) while avoiding neuraxial or general anesthesia. This was a preliminary experience with two geriatric patients with hip fracture, American Society of Anesthesiologists status III, and with many comorbidities. Neither patient could be operated on within 48 h after admission. Both general anesthesia and neuraxial anesthesia were high-risk procedures and had contraindications. Hence, we chose nerve block combined with a small amount of sedation. Intraoperative analgesia was provided by single-injection ultrasound-guided FICB. Light intravenous sedation was added. Surgical exposure was satisfactory, and neither patient complained of any symptoms during the procedure.
This report showed that hip surgery for geriatric patients can be performed with FICB and MAC, although complications and contraindications are common. The anesthetic program was accompanied by stable respiratory and circulatory system responses and satisfactory analgesia while avoiding the adverse effects and problems associated with either neuraxial or general anesthesia.
Core Tip: In clinical practice, we may encounter some elderly patients with many complications. As both general anesthesia and neuraxial anesthesia have high risks and contraindications, we chose nerve block combined with small amount of sedation. In this report, we describe administration of fascia iliaca compartment block in combination with low dose intravenous anesthesia to two geriatric patients, with satisfactory anesthetic effect. Anatomical diagrams and ultrasound imaging can, at a glance, promote this technique.