RESUMEN
The authors describe in a clinical case series (nâ¯= 7) of older (age 78-95 years) high-risk patients the successful surgical treatment of proximal femoral fractures in a peripheral regional anesthesia technique. After positioning on the non-fractured side, a double injection technique (dual guidance concept: sonography plus nerve stimulation) was chosen. The injections were performed parasacrally (blockade of the sacral plexus under the piriformis muscle) and lumbar-paravertebrally (psoas compartment block and transmuscular quadratus lumborum block). Per block 15â¯ml ropivacaine 0.5% or 20â¯ml ropivacaine 0.375% was administered. The total dose of 225â¯mg ropivacaine was never exceeded. In 5 out of 7 cases a supplemental medication with 2 times 5⯵g sufentanil (nâ¯= 2) and/or 1-1.5â¯mg/kg body weight and h propofol (nâ¯= 4) was administered with spontaneous breathing. In addition to potential benefits, the authors also discuss limitations of the procedure, for example by the use of oral anticoagulants.