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Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique

INTRODUCTION: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anes...

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Autores principales: Aissa, Ismail, Wartiti, Loukman El, Bouhaba, Najib, Khallikane, Said, Moutaoukil, Mohamed, Kartite, Noureddine, Elkoundi, Abdelghafour, Benakrout, Aziz, Chlouchi, Abdellatif, Elbouti, Anas, Najout, Hamza, Grine, Ali, Touab, Reda, Zaizi, Abderrahim, Youssef, Jalal, Bakkali, Hicham, Balkhi, Hicham, Bensghir, Mustapha
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The African Field Epidemiology Network 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532854/
https://www.ncbi.nlm.nih.gov/pubmed/33062115
http://dx.doi.org/10.11604/pamj.2020.37.12.21392
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author Aissa, Ismail
Wartiti, Loukman El
Bouhaba, Najib
Khallikane, Said
Moutaoukil, Mohamed
Kartite, Noureddine
Elkoundi, Abdelghafour
Benakrout, Aziz
Chlouchi, Abdellatif
Elbouti, Anas
Najout, Hamza
Grine, Ali
Touab, Reda
Zaizi, Abderrahim
Youssef, Jalal
Bakkali, Hicham
Balkhi, Hicham
Bensghir, Mustapha
author_facet Aissa, Ismail
Wartiti, Loukman El
Bouhaba, Najib
Khallikane, Said
Moutaoukil, Mohamed
Kartite, Noureddine
Elkoundi, Abdelghafour
Benakrout, Aziz
Chlouchi, Abdellatif
Elbouti, Anas
Najout, Hamza
Grine, Ali
Touab, Reda
Zaizi, Abderrahim
Youssef, Jalal
Bakkali, Hicham
Balkhi, Hicham
Bensghir, Mustapha
author_sort Aissa, Ismail
collection PubMed
description INTRODUCTION: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures. METHODS: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications. RESULTS: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery. CONCLUSION: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia.
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spelling pubmed-75328542020-10-13 Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique Aissa, Ismail Wartiti, Loukman El Bouhaba, Najib Khallikane, Said Moutaoukil, Mohamed Kartite, Noureddine Elkoundi, Abdelghafour Benakrout, Aziz Chlouchi, Abdellatif Elbouti, Anas Najout, Hamza Grine, Ali Touab, Reda Zaizi, Abderrahim Youssef, Jalal Bakkali, Hicham Balkhi, Hicham Bensghir, Mustapha Pan Afr Med J Research INTRODUCTION: emergency surgery for pertrochanteric femoral fractures (PFF) in patients at high risk of anaesthetic complications is a real challenge for surgeons due to the increased intraoperative risk. We report our experience with combined lumbar plexus-sciatic nerve block as an alternative anesthetic technique for these fractures. METHODS: we conducted a three-year descriptive, single-center, cross-sectional study including patients with a history of recent pertrochanteric femoral fractures (PFF) at high risk anaesthetic complications. Combined lumbar plexus-sciatic nerve block was performed using the common neurostimulation technique. A mixture of 20ml of lidocaine 2% and bupivacaine 0.5% (50/50) was injected into each block. The primary endpoint was the effectiveness of lumbar plexus-sciatic nerve block assessed through the rates from anesthesia-related failures defined as need for conversion into general anaesthesia (GA). The secondary endpoints were: 1) anesthetic technique, 2) intraoperative hemodynamic, respiratory and neurological impairment, and 3) outcomes and potential postoperative complications. RESULTS: the study included 30 patients. The average age of patients was 74 ± 10 years. The average admission time in the Department of Emergency Surgery was 12(5-36) hours. The average duration of the procedure was 15.20 ± 3.45 minutes. No conversion into GA was necessary. There were no statistically significant differences between the various recorded intraoperative hemodynamic and respiratory parameters (MAP, HR, SpO2) (p > 0,05). Surgical procedure duration was 46 ± 5 minutes. Surgical satisfaction was 9.7 ± 0.1. The first post-operative analgesic treatment was started after 8(1-24) hours. All patients had complete sensorimotor recovery. CONCLUSION: combined lumbar plexus-sciatic nerve block is an anesthetic alternative for urgent PFF surgery in patients at high risk of anaesthetic complications: reduced operative delays, anesthetic efficiency, hemodynamic and intraoperative respiratory stability, absence of complications due to other anesthetic techniques, rapid admission to recovery room, and good postoperative analgesia. The African Field Epidemiology Network 2020-09-03 /pmc/articles/PMC7532854/ /pubmed/33062115 http://dx.doi.org/10.11604/pamj.2020.37.12.21392 Text en Copyright: Ismail Aissa et al. https://creativecommons.org/licenses/by/4.0 The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Aissa, Ismail
Wartiti, Loukman El
Bouhaba, Najib
Khallikane, Said
Moutaoukil, Mohamed
Kartite, Noureddine
Elkoundi, Abdelghafour
Benakrout, Aziz
Chlouchi, Abdellatif
Elbouti, Anas
Najout, Hamza
Grine, Ali
Touab, Reda
Zaizi, Abderrahim
Youssef, Jalal
Bakkali, Hicham
Balkhi, Hicham
Bensghir, Mustapha
Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title_full Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title_fullStr Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title_full_unstemmed Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title_short Bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
title_sort bibloc lombaire et sciatique plexique pour la chirurgie urgente des fractures pertrochantériennes: une technique alternative chez les patients à haut risque anesthésique
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7532854/
https://www.ncbi.nlm.nih.gov/pubmed/33062115
http://dx.doi.org/10.11604/pamj.2020.37.12.21392
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