Fracture de hanche chez le sujet agé opéré sous rachianesthésie titré analgésique continue

étude rétrospective au CHU Bab El Oued

Abstract

Anesthesia of the elderly patient for hip fracture (Fr) is a daily problem in emergencies. The ageing of the Algerian and world population is a social and demographic reality. Polypathological field, polymedicamentous whose anaesthetic management represents a challenge the continuous titrated spinal anesthesia (CTSA) is a technique proposed in this indication
Propose a dose of local anaesthetic (LA) lower than usual
Methods:
This Retrospective study was carried on 40 elderly patients aged >65 years undergoing hip fracture. The patients received intermittent dosing of local anesthetic solution via an intrathecal catheter using 0.25 ml of 0.5% isobaric bupivacaine increments and 0.25 ml of fentanyl (12,5 μg). The study regarded hemodynamic stability, incidence of hypotension, highestlevel of sensory and motor blockade, total ephedrine consumption and the satisfaction of patients and surgeon’s
Results
female predominance, the mean age was 75 years of which 72% were ASA ≥ III. Pertrochanteric fractures 47% followed femoral neck 53%. The sensory level ≥ D10 in almost all patients. The failures were 2%, Complement sedation in 20% of patients with conversion to general anesthesia in one patient. The complications are represented by arterial hypotension 3% the use of vasoconstrictors 2%, bradycardia 0.8%. All patients and operators were satisfied
Conclusions:
Our results show CTSA is effective, allows the administration of low doses of (AL), provides good hemodynamic stability in elderly patients, high risk with few side effects. Simple realization and low cost.