Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly.

BACKGROUND AND OBJECTIVES: This prospective randomized study was designed to determine the hemodynamic effects and quality of combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia in the elderly for repair of proximal femoral fractures. METHODS: Twenty-nine elderly patients ranging in age from 68 to 97 years were randomly assigned to 2 groups: a spinal anesthesia group with single-shot 3 mL 0.5% plain bupivacaine, and a combined block group with 30 mL lidocaine 1.33% with epinephrine for the posterior lumbar plexus block and 10 mL same mixture for the parasacral block and an iliac crest block with 5 mL lidocaine 1%. RESULTS: No need for general anesthesia was encountered in either group. Anesthesia was judged unsatisfactory in 1 of 15 patients in the combined block group. The initial decrease of mean arterial pressure was 38% in the spinal group and 27% in the block group and was not significantly different. A more prolonged hemodynamic effect was found in the spinal group, indicated by the more frequent use of ephedrine to stabilize blood pressure (P<.05). Patients over 85 years had a significantly larger decrease in blood pressure than younger patients (P<.01). CONCLUSIONS: Plain bupivacaine spinal anesthesia and combined lumbar/sacral plexus block provided adequate anesthesia for repair of hip fracture in the elderly. Hypotension was induced by both the combined peripheral nerve block and plain bupivacaine spinal anesthesia in aged patients; hypotension was found to be longer lasting after spinal anesthesia and of a larger magnitude in patients over 85 years of age.

[Block of the lateral perforant branches of the subcostal and iliohypogastric nerves for proximal femur surgery]. / Bloc des branches perforantes latérales des nerfs sous-costal et iliohypogastrique pour la chirurgie proximale du fémur.

We describe an original method to block the lateral cutaneous rami of the subcostal and iliohypogastric nerves or'iliac crest point block'to complete plexular block of the lower limb for hip surgery. The local anaesthetic is injected in front of an osterofibrous orifice of the iliac crest. In nine cases out of ten, the lateral cutaneous rami of the iliohypogastric nerve pass through this orifice and in one case out of ten, it is the one arising from the subcostal nerve. This complementary block allows the surgical incision at the level of the great trochanter.