Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study
Background Although subarachnoid block (SAB) is the most popular regional anesthesia (RA) technique for fixation of femur fractures, continuous lumbar epidural (CLE) anesthesia, and lumbosacral plexus blocks (LSPB) are also employed in specific situations. The choice of RA technique depends on eithe...
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| creator | Diwan, Sandeep Van Zundert, André Nair, Abhijit Sancheti, Parag K Pradhan, Chetan Puram, Chetan |
| description | Background Although subarachnoid block (SAB) is the most popular regional anesthesia (RA) technique for fixation of femur fractures, continuous lumbar epidural (CLE) anesthesia, and lumbosacral plexus blocks (LSPB) are also employed in specific situations. The choice of RA technique depends on either the choice of the anesthesiologist or based on the underlying comorbidities. At our institute, we anesthetize elderly patients who come for fixation of femur fracture with multiple comorbidities using RA techniques as mentioned based on comorbidities and overall general condition. Methods In a cohort of 184 elderly patients, we analyzed RA techniques employed over a period of five years in elderly patients admitted with fractures of the proximal femur, its hemodynamic implications and thus attempted to find the suitable RA technique with minimal adverse events after ethics committee approval. We also compared the length of stay in the hospital in relation to RA techniques. Results The demographic data was comparable with no significant difference in administering the three RA techniques. SAB, CLE and LSPB was implemented at 33.33%, 35.96%, and 30.7% respectively. Perioperative noradrenaline infusion was a feature in patients who received SAB (p |
| doi_str_mv | 10.7759/cureus.19392 |
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The choice of RA technique depends on either the choice of the anesthesiologist or based on the underlying comorbidities. At our institute, we anesthetize elderly patients who come for fixation of femur fracture with multiple comorbidities using RA techniques as mentioned based on comorbidities and overall general condition. Methods In a cohort of 184 elderly patients, we analyzed RA techniques employed over a period of five years in elderly patients admitted with fractures of the proximal femur, its hemodynamic implications and thus attempted to find the suitable RA technique with minimal adverse events after ethics committee approval. We also compared the length of stay in the hospital in relation to RA techniques. Results The demographic data was comparable with no significant difference in administering the three RA techniques. SAB, CLE and LSPB was implemented at 33.33%, 35.96%, and 30.7% respectively. Perioperative noradrenaline infusion was a feature in patients who received SAB (p<0/001). The higher number of CLE and LSPB patients had a length of stay of fewer than 48 hours whereas most SAB patients had a length of stay of more than 48 hrs (p<0.001). Conclusion Elderly patients with multiple comorbidities should be offered CLE instead of SAB so as to maintain stable hemodynamics. RA technique in an elderly patient with multiple comorbidities should be standardized so as to provide uneventful surgical anesthesia.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.19392</identifier><identifier>PMID: 34925994</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Anesthesiology ; Bone surgery ; Cardiovascular disease ; Catheters ; Coronary vessels ; Epidural ; Fractures ; Length of stay ; Medical personnel ; Medical records ; Molecular weight ; Mortality ; Older people ; Orthopedics ; Pain Management ; Regional anesthesia ; Standard deviation ; Trauma ; Vein & artery diseases</subject><ispartof>Curēus (Palo Alto, CA), 2021-11, Vol.13 (11), p.e19392-e19392</ispartof><rights>Copyright © 2021, Diwan et al.</rights><rights>Copyright © 2021, Diwan et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2021, Diwan et al. 2021 Diwan et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c299t-64ebc601c48a20380aed6a95e0b56522ee5ba29fda08330fd96d99d6c929e2c23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655708/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8655708/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,27924,27925,53791,53793</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34925994$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Diwan, Sandeep</creatorcontrib><creatorcontrib>Van Zundert, André</creatorcontrib><creatorcontrib>Nair, Abhijit</creatorcontrib><creatorcontrib>Sancheti, Parag K</creatorcontrib><creatorcontrib>Pradhan, Chetan</creatorcontrib><creatorcontrib>Puram, Chetan</creatorcontrib><title>Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Background Although subarachnoid block (SAB) is the most popular regional anesthesia (RA) technique for fixation of femur fractures, continuous lumbar epidural (CLE) anesthesia, and lumbosacral plexus blocks (LSPB) are also employed in specific situations. The choice of RA technique depends on either the choice of the anesthesiologist or based on the underlying comorbidities. At our institute, we anesthetize elderly patients who come for fixation of femur fracture with multiple comorbidities using RA techniques as mentioned based on comorbidities and overall general condition. Methods In a cohort of 184 elderly patients, we analyzed RA techniques employed over a period of five years in elderly patients admitted with fractures of the proximal femur, its hemodynamic implications and thus attempted to find the suitable RA technique with minimal adverse events after ethics committee approval. We also compared the length of stay in the hospital in relation to RA techniques. Results The demographic data was comparable with no significant difference in administering the three RA techniques. SAB, CLE and LSPB was implemented at 33.33%, 35.96%, and 30.7% respectively. Perioperative noradrenaline infusion was a feature in patients who received SAB (p<0/001). The higher number of CLE and LSPB patients had a length of stay of fewer than 48 hours whereas most SAB patients had a length of stay of more than 48 hrs (p<0.001). Conclusion Elderly patients with multiple comorbidities should be offered CLE instead of SAB so as to maintain stable hemodynamics. RA technique in an elderly patient with multiple comorbidities should be standardized so as to provide uneventful surgical anesthesia.</description><subject>Anesthesiology</subject><subject>Bone surgery</subject><subject>Cardiovascular disease</subject><subject>Catheters</subject><subject>Coronary vessels</subject><subject>Epidural</subject><subject>Fractures</subject><subject>Length of stay</subject><subject>Medical personnel</subject><subject>Medical records</subject><subject>Molecular weight</subject><subject>Mortality</subject><subject>Older people</subject><subject>Orthopedics</subject><subject>Pain Management</subject><subject>Regional anesthesia</subject><subject>Standard deviation</subject><subject>Trauma</subject><subject>Vein & artery diseases</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNpdkc9rFDEYhoMotqy9eZaAFw_dmnwzk5l4EJbSrYVCi1Y8hmzyTTdlZrLmR3Fv_unNurVUc0kgDw_v972EvOXspG0b-dHkgDmecFlJeEEOgYtu3vGufvnsfUCOYrxjjHHWAmvZa3JQ1RIaKetD8vti3GiTqJ4svcrJ-BEj9T39irfOT3qgiwljWmN0mt6gWU_uZy6Em-jZYDEMW3qtk8MpRfrDpTVdhmIroXaO6-B_ubE4ljjm8IkuijUFHzdokrtH-i1lu31DXvV6iHj0eM_I9-XZzemX-eXV-cXp4nJuQMo0FzWujGDc1J0GVnVMoxVaNshWjWgAEJuVBtlbzbqqYr2VwkpphZEgEQxUM_J5793k1YjWlMhBD2oTSsKwVV479e_P5Nbq1t-rTjRNW6Qz8uFREPxuB0mNLhocBj2hz1GB4MAASpaCvv8PvfM5lG3uKAApeDmFOt5TpuwkBuyfwnCmdu2qfbvqT7sFf_d8gCf4b5fVA0zxo3U</recordid><startdate>20211109</startdate><enddate>20211109</enddate><creator>Diwan, Sandeep</creator><creator>Van Zundert, André</creator><creator>Nair, Abhijit</creator><creator>Sancheti, Parag K</creator><creator>Pradhan, Chetan</creator><creator>Puram, Chetan</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope></search><sort><creationdate>20211109</creationdate><title>Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study</title><author>Diwan, Sandeep ; Van Zundert, André ; Nair, Abhijit ; Sancheti, Parag K ; Pradhan, Chetan ; Puram, Chetan</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c299t-64ebc601c48a20380aed6a95e0b56522ee5ba29fda08330fd96d99d6c929e2c23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Anesthesiology</topic><topic>Bone surgery</topic><topic>Cardiovascular disease</topic><topic>Catheters</topic><topic>Coronary vessels</topic><topic>Epidural</topic><topic>Fractures</topic><topic>Length of stay</topic><topic>Medical personnel</topic><topic>Medical records</topic><topic>Molecular weight</topic><topic>Mortality</topic><topic>Older people</topic><topic>Orthopedics</topic><topic>Pain Management</topic><topic>Regional anesthesia</topic><topic>Standard deviation</topic><topic>Trauma</topic><topic>Vein & artery diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Diwan, Sandeep</creatorcontrib><creatorcontrib>Van Zundert, André</creatorcontrib><creatorcontrib>Nair, Abhijit</creatorcontrib><creatorcontrib>Sancheti, Parag K</creatorcontrib><creatorcontrib>Pradhan, Chetan</creatorcontrib><creatorcontrib>Puram, Chetan</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Diwan, Sandeep</au><au>Van Zundert, André</au><au>Nair, Abhijit</au><au>Sancheti, Parag K</au><au>Pradhan, Chetan</au><au>Puram, Chetan</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2021-11-09</date><risdate>2021</risdate><volume>13</volume><issue>11</issue><spage>e19392</spage><epage>e19392</epage><pages>e19392-e19392</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Background Although subarachnoid block (SAB) is the most popular regional anesthesia (RA) technique for fixation of femur fractures, continuous lumbar epidural (CLE) anesthesia, and lumbosacral plexus blocks (LSPB) are also employed in specific situations. The choice of RA technique depends on either the choice of the anesthesiologist or based on the underlying comorbidities. At our institute, we anesthetize elderly patients who come for fixation of femur fracture with multiple comorbidities using RA techniques as mentioned based on comorbidities and overall general condition. Methods In a cohort of 184 elderly patients, we analyzed RA techniques employed over a period of five years in elderly patients admitted with fractures of the proximal femur, its hemodynamic implications and thus attempted to find the suitable RA technique with minimal adverse events after ethics committee approval. We also compared the length of stay in the hospital in relation to RA techniques. Results The demographic data was comparable with no significant difference in administering the three RA techniques. SAB, CLE and LSPB was implemented at 33.33%, 35.96%, and 30.7% respectively. Perioperative noradrenaline infusion was a feature in patients who received SAB (p<0/001). The higher number of CLE and LSPB patients had a length of stay of fewer than 48 hours whereas most SAB patients had a length of stay of more than 48 hrs (p<0.001). Conclusion Elderly patients with multiple comorbidities should be offered CLE instead of SAB so as to maintain stable hemodynamics. RA technique in an elderly patient with multiple comorbidities should be standardized so as to provide uneventful surgical anesthesia.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>34925994</pmid><doi>10.7759/cureus.19392</doi><oa>free_for_read</oa></addata></record> |
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| subjects | Anesthesiology Bone surgery Cardiovascular disease Catheters Coronary vessels Epidural Fractures Length of stay Medical personnel Medical records Molecular weight Mortality Older people Orthopedics Pain Management Regional anesthesia Standard deviation Trauma Vein & artery diseases |
| title | Impact and Outcomes of Regional Anesthesia Techniques in Elderly Patients With Fracture of Proximal Femur: A Retrospective Study |
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