Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
Warren Alpert School of Medicine, Brown University, Providence, RI, USA.
Orthop Traumatol Surg Res. 2023 Nov;109(7):103619. doi: 10.1016/j.otsr.2023.103619. Epub 2023 Apr 11.
Proximal femur fractures have high rates of morbidity, mortality, and perioperative complications. Limiting anesthesia, especially in the elderly population, is a priority from a medical perspective. The goal of the current study is to present a technique of using local anesthetic with monitored anesthesia care (MAC) for the fixation of intertrochanteric (IT) femur fractures with cephalomedullary nailing (CMN), provide early clinical results in a small series of patients, and evaluate the safety, efficiency, and anesthetic efficacy of our technique.
The use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia.
Patients undergoing cephalomedullary nailing (CMN) with a long nail for IT femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi, linear regression, and two-sampled T-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group.
Thirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions.
Local anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia.
III, therapeutic.
股骨近端骨折的发病率、死亡率和围手术期并发症都很高。从医学角度来看，限制麻醉（尤其是在老年人群中）是首要任务。本研究的目的是介绍一种使用局部麻醉联合监测麻醉护理（MAC）治疗股骨转子间（IT）骨折并使用股骨近端髓内钉（CMN）固定的技术，为一小批患者提供早期临床结果，并评估我们技术的安全性、效率和麻醉效果。
与全身麻醉和椎管内麻醉相比，仅使用局部麻醉联合 MAC 用于固定 IT 骨折是安全的，并可缩短手术时间。
回顾性地从一个前瞻性收集的患者登记处确定了 2020 年 1 月至 2021 年 6 月间由同一位外科医生进行的使用长钉治疗股骨转子间骨折的 CMN 手术的患者。收集了患者的人口统计学资料、手术时间、住院时间、围手术期用药和并发症。使用方差分析、卡方检验、线性回归和两样本 T 检验分析局部麻醉组与全身麻醉组和椎管内麻醉组之间的潜在差异。
确定了 37 例患者。11 例患者使用局部麻醉联合 MAC 进行 CMN，11 例患者使用椎管内麻醉，15 例患者使用全身麻醉。与其他麻醉技术相比，局部麻醉组的手术室时间和麻醉诱导至切口时间明显缩短。局部麻醉组在手术中也倾向于较少使用血管加压药，术后谵妄发生率较低。术中阿片类药物使用、并发症、患者死亡率或住院再入院率无差异。
与全身麻醉和椎管内麻醉相比，MAC 用于治疗 IT 骨折并使用 CMN 与缩短手术时间相关，并且在输血、再入院和死亡率等并发症发生率方面与全身麻醉和椎管内麻醉相似。
III，治疗性。
