Impact of Anesthesia selection on Post-Op Pain Management in Operatively treated Hip Fractures

Comparison of the effects of two regional anesthetic techniques on pain during high risk hip fracture surgery

OBJECTIVES

In this study, we evaluated perioperative pain management using the Analgesia Nociception Index (ANI) monitoring in high-risk ASA III-IV patients scheduled for hip surgery. Specifically, we examined the lumbar plexus (LP), sacral plexus (SP), and supra-inguinal fascia iliaca compartment blocks (SIFIB), as well as combinations of SP blocks.

METHODS

In this prospective observational study, we included 74 patients who were assigned to one of two groups: Group L, which received LP and SP blocks, and Group F, which received SIFIB and SP blocks. Surgery was performed after confirming the sensory block with the pinprick test and applying the sedation protocol. Sedation levels were evaluated using the BIS monitor whereas analgesic requirements were assessed using the ANI monitor. Demographic data, including age, sex, ASA score, SpO2, heart rate (HR), mean arterial pressure (MAP), duration of sensorimotor block, type and duration of surgery, time to first analgesic use, and total analgesic consumption, were recorded. Visual analog scale (VAS) scores at 0, 6, 12, and 24 h additional analgesic requirements, and satisfaction ratings from patients and surgeons were also evaluated.

RESULTS

Compared to Group F, Group L presented significantly greater ANI values at 30, 60, 90 min intraoperatively, as well as at 6 and 12 h postoperatively. The VAS scores were consistently higher in Group F than in Group L at all measurement times.

CONCLUSION

Group L provided better analgesia, required fewer sedatives during surgery, and had greater satisfaction among patients and surgeons. A negative correlation was found between the VAS score and ANI for assessing patient pain.

Management of Hip Fractures

Hip fractures in women are a serious health concern, demanding prompt treatment and pain control methods. This study examines fracture frequency, diagnostic techniques, and classification, focusing on femoral neck and intertrochanteric fractures. It discusses risk factors including age, gender, bone strength, and medication and their impact on fracture risk. Treatments range from noninvasive care to surgeries such as internal fixation and joint replacement. Perioperative measures such as anesthesia, antibiotics, and clot prevention to improve outcomes and lessen complications are also discussed. Postsurgery care emphasizes pain relief strategies, including opioids, nerve blocks, and modern methods such as real-time messaging for pain control.

Nerve block reduces the incidence of 3-year postoperative mortality: a retrospective cohort study

Purpose

A retrospective cohort study was performed to determine the effect of nerve block on the incidence of postoperative mortality in patients with hip replacement.

Methods

According to the inclusion and exclusion criteria, patients who were undergoing hip replacement for the first time under general or intraspinal anesthesia, classified as ASA class I-IV, and aged ≥65 years were selected. We collected the general data, past medical history, preoperative laboratory test results, perioperative fluid intake and outflow data, perioperative anesthesia and related drug data, postoperative laboratory results, and correlation time index. Patients with preoperative combined nerve block were included in the N group, and those without combined nerve block were included in the NN group. The patients were followed up via telephone call to assess survival outcomes at 3 years after surgery. Propensity score matching and uni- and multivariate analyses were performed to determine the influence of nerve block and other related factors on postoperative mortality.

Results

A total of 743 patients were included in this study, including 262 in the N group and 481 in the NN group. Two hundred five patients in both groups remained after propensity score matching. Main result: Preoperative nerve block was associated with reduced mortality three years after surgery.

Conclusion

Nerve block reduces the incidence of 3-year postoperative mortality, and composite nerve block with general anesthesia and neuraxial anesthesia is worthy of promotion.

Pre-emptive infiltration with betamethasone and ropivacaine for postoperative pain in laminoplasty and laminectomy (PRE-EASE): a prospective randomized controlled trial

BACKGROUND

Postoperative pain after laminoplasty and laminectomy occurs partially from local trauma of the paraspinal tissue. Finding a multimodal analgesic cocktail to enhance the duration and effect of local infiltration analgesia is crucial. Because of the rapid onset and long duration of action of betamethasone, the authors hypothesized that, a pre-emptive multimodal infiltration regimen of betamethasone and ropivacaine reduces pain scores and opioid demand, and improves patient satisfaction following laminoplasty and laminectomy.

MATERIALS AND METHODS

This prospective, randomized, open-label, blinded endpoint study was conducted between 1 September 2021 and 3 June 2022, and included patients between the ages of 18 and 64 scheduled for elective laminoplasty or laminectomy under general anesthesia, with American Society of Anesthesiologists classification I/II. One hundred sixteen patients were randomly assigned to either the BR (Betamethasone-Ropivacaine) group or the R (Ropivacaine) group in a 1:1 ratio. Each group received pre-emptive infiltration of a total of 10 ml study solution into each level. Every 30 ml of study solution composed of 0.5 ml of betamethasone plus 14.5 ml of saline and 15 ml of 1% ropivacaine for the BR group, and 15 ml of 1% ropivacaine added to 15 ml of saline for the R group. Infiltration of epidural space and intrathecal space were avoided and the spinous process, transverse process, facet joints, and lamina were injected, along with paravertebral muscles and subcutaneous tissue. Cumulative 48 h postoperative butorphanol consumption via PCA (Patient-controlled analgesia) was the primary outcome. Intention-to-treat (ITT) principle was used for primary analysis.

RESULTS

Baseline characteristics were identical in both groups ( P >0.05). The cumulative 48 h postoperative butorphanol consumption via PCA was 3.0±1.4 mg in the BR group ( n =58), and 7.1±1.2 mg in the R group ( n =58) ( P <0.001). Overall cumulative opioid demand was lower at different time intervals in the BR group ( P <0.001), along with the estimated median time of first analgesia demand via PCA (3.3 h in the BR group and 1.6 h in the R group). The visual analog scale (VAS) score at movement and rest were also significantly lower until 3 months and 6 weeks, respectively. No side effects or adverse events associated with the intervention were observed in this study.

CONCLUSIONS

Pre-emptive analgesia with betamethasone and ropivacaine provides better postoperative pain management following laminoplasty and laminectomy, compared to ropivacaine alone. This is an effective technique worthy of further evaluation.