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Operative Versorgung hüftgelenknaher Femurfrakturen bei geriatrischen Patienten mit hohem Narkoserisiko in peripherer Regionalanästhesie

Eine klinische Fallserie

Surgical treatment of proximal femoral fractures in high-risk geriatric patients under peripheral regional anesthesia

A clinical case series

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Zusammenfassung

Die Autoren beschreiben in einer klinischen Fallserie (n = 7) älterer (Alter 78 bis 95 Jahre) Hochrisikopatienten die erfolgreiche operative Versorgung von hüftgelenknahen Frakturen in einem peripheren Regionalanästhesieverfahren. Nach Lagerung auf die nichtfrakturierte Seite wurde eine Doppelinjektionstechnik (Dual-guidance-Konzept: Sonographie plus Nervenstimulation) durchgeführt. Die Injektionen erfolgten parasakral (Blockade des Plexus sacralis unter dem M. piriformis) und lumbal-paravertebral (Psoaskompartmentblock und transmuskulärer Quadratus-Lumborum-Block). Pro Block wurden 15 ml Ropivacain 0,5 % bzw. 20 ml Ropivacain 0,375 % appliziert. Die Gesamtdosis von 225 mg Ropivacain wurde in keinem Fall überschritten.

Abstract

The authors describe in a clinical case series (n = 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 15 ml ropivacaine 0.5% or 20 ml ropivacaine 0.375% was administered. The total dose of 225 mg ropivacaine was never exceeded. In 5 out of 7 cases a supplemental medication with 2 times 5 μg sufentanil (n = 2) and/or 1–1.5 mg/kg body weight and h propofol (n = 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.

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Authors and Affiliations

  1. Klinik für Anästhesiologie, HELIOS-Kliniken Schwerin, Wismarsche Straße 393–7, 19049, Schwerin, Deutschland

    R. Seidel & E. Barbakow

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  1. R. Seidel
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  2. E. Barbakow
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Correspondence to R. Seidel.

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Interessenkonflikt

R. Seidel und E. Barbakow haben Vortragshonorare von USRA Medical Education erhalten.

Alle im vorliegenden Manuskript beschriebenen Untersuchungen am Menschen wurden mit Zustimmung der zuständigen Ethikkommission, im Einklang mit nationalem Recht sowie gemäß der Deklaration von Helsinki von 1975 (in der aktuellen, überarbeiteten Fassung) durchgeführt. Von allen beteiligten Patienten liegt eine Einverständniserklärung vor.

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Seidel, R., Barbakow, E. Operative Versorgung hüftgelenknaher Femurfrakturen bei geriatrischen Patienten mit hohem Narkoserisiko in peripherer Regionalanästhesie. Anaesthesist 68, 108–114 (2019). https://doi.org/10.1007/s00101-019-0537-7

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  • DOI: https://doi.org/10.1007/s00101-019-0537-7

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