Abstract
LATERAL INGUINAL LUMBAR PLEXUS IN ELDERLY PATIENTS WITH FEMUR FRACTURE IN ANTALGIC POSITION FOR ANALGESIA BEFORE SURGERY AND POSTOPERATIVE ANALGESIA

*Luiz Eduardo Imbelloni – MD, PhD, Douglas M. P. Teixeira – MD, Thaís Bezerra Ventura – MD, Bruno Brasileiro – MD, Robson Barbosa – MD, Micaela Barbosa L. Sales – MD, Márcio Duarte – MD, Edvan Benevides de Freitas Junior – MD and Geraldo Borges de Morais Filho, MSc

ABSTRACT

Background. Femur fracture in an elderly patient presents with very severe pain, often leading to the antalgic position of the fractured limb. Lateral access to the inguinal lumbar plexus provides comfort and safety with long-lasting analgesia. The aim of this study was to evaluate the efficacy of a single injection of 20 ml of 0.25% levobupivacaine (S75:R25) and 20 ml of 2% lidocaine with epinephrine through neurostimulator-assisted for pain relief before spinal anesthesia and providing postoperative analgesia. Methods. Two hundred and forty elderly patients with a femur fracture received a lumbar plexus block in the lateral access to the anterior lumbar plexus before surgery to improve pain (antalgic position) and subsequent spinal anesthesia. The patients were followed-up for 24 hours for checking the presence of complications at the blockage site, and time of postoperative analgesia, and the moment of the first pain complaint was recorded for patients not receiving additional analgesics. Results. Predominance of females (68%) compared to males (32%). All patients presented sufficient analgesia in 10 minutes to be placed in a sitting position for spinal puncture. In the pain assessment by the proposed scale, 233 patients had excellent analgesia, only 7 patients had some degree of pain, not requiring the use of dextroketamine. The mean duration of analgesia was 21.15±3.59 for postoperative pain control, ranging from 13 to 30 hours. No complication at puncture site was seen throughout follow up time. Conclusion. The results of this study demonstrate that the lateral lumbar plexus block in the antalgic position is an effective, safe and easy analgesic method and with the anesthetic solution used provides an excellent quality of postoperative analgesia with minimal rescue drugs. This technique confirmed that there is no need for deep sedation, nor the use of opioids or dextroketamine for placement in the position for spinal anesthesia.

Keywords: Electric nerve stimulation, Lateral lumbar block, Levopubivacaine, Lidocaine, Complications, Elderly femur fracture.


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