Peripheral nerve block (Tetra block) - an effective alternative anesthesia for patients undergoing fractured femur neck surgery with recent myocardial infarction and low ejection fraction: a case report

Title: Peripheral nerve block (Tetra block) - an effective alternative anesthesia for patients undergoing fractured femur neck surgery with recent myocardial infarction and low ejection fraction: a case report

Authors: Dr Anu Ambooken, Dr Chinchu Rose Steby, Dr Jinny John

DOI: https://dx.doi.org/10.18535/jmscr/v12i06.05

Abstract

The fractured neck of the femur (NOF) is a common injury among the elderly population¹. Ischemic heart disease (IHD)is a common comorbid condition in these patients, and recent myocardial infarction (MI)adds a unique challenge for the anesthesiologist¹. The best timing for the surgery is known to be the day of admission or the day after admission. However, this poses a challenge due to patients possibly being on antiplatelet or anticoagulant therapy, which means central neuraxial blockade is not an option¹. General anesthesia (GA) for these patients can lead to cardiovascular and respiratory instability due to associated low ejection fraction (EF)². Hemodynamic fluctuations related to anesthesia can be harmful. In this case study, a patient with a NOF fracture and a recent MI with a low EF underwent hemiarthroplasty. The procedure used a peripheral nerve block (PNB) alongside sedation as the sole anesthetic technique. The patient remained stable throughout the surgery and in the postoperative period.

Keywords: Neck of femur fracture, Myocardial Infarction, Peripheral Nerve Block, Tetra block, Loco-regional, Ejection Fraction.

References

Klimkiewicz, J.; Klimkiewicz, A.; Gutowski, M.; Rustecki, B.; Kochanowski, D.; Ryczek, R.; Lubas, A. Femoral and Lateral Femoral Cutaneous Nerve Block as Anesthesia for High-Risk Intertrochanteric Fracture Repair Patients. J. Clin. Med. 2022, 11, 3708. https://doi.org/10.3390/ jcm11133708
Umesh B, Deshmukh R. Bipolar Hemiarthroplasty of Hip in an Unstable Angina Patient: A Case Report. J Orthop Case Rep. 2018 Nov-Dec;8(6):42-45. doi: 10.13107/jocr.2250-0685.1250. PMID: 30915292; PMCID: PMC6424317.
Rostagno C, Cammilli A, Di Cristo A, Polidori GL, Ranalli C, Cartei A, Buzzi R, Prisco D. Acute coronary syndromes with significant troponin increase in patients with hip fracture prior to surgical repair: differential diagnosis and clinical implications. Intern Emerg Med. 2016 Mar;11(2):219-24. doi: 10.1007/s11739-015-1348-8. Epub 2015 Nov 12. PMID: 26563767.
Komarasamy B, Forster MC, Esler CN, Harper WM, Hall AP. Mortality following hip fracture surgery in patients with recent myocardial infarction. The Annals of The Royal College of Surgeons of England. 2007 Jul;89(5):521-5.
Chandran P, Perween R, John B, Shajahan MS, Ramesh R. Graded Epidural Anaesthesia as the Sole Anaesthetic Technique for Bilateral Total Knee Replacement in a Patient with Low Ejection Fraction: A Case Report. Archives of Anesthesiology and Critical Care. 2022 Nov 7;8(Supplement):420-2.

Call For Paper Volume 12 Issue 12 December 2024

The JMSCR is accepting manuscripts for its coming issues to be Publish Volume 12 Issue 12 December 2024 the JMSCR invites authors to submit manuscripts Reporting original medical research, original article, research article, case report, systematic reviews, or educational Innovations for publication for the coming issues that will be released in Volume 12 Issue 12 December 2024. Types of manuscripts suitable for JMSCR include: Medical research, Clinical research Educational Innovation, Brief Report, Reviews on Teaching In keeping with high quality scholarship, Read More.....

https://jmscr.igmpublication.org/ems/index.php/jmscr/about/submissions

If any difficulty you can also submit to: This email address is being protected from spambots. You need JavaScript enabled to view it.

JMSCR Menu

Impact Factor SJIF 2024: 7.892

https://sjifactor.com/passport.php?id=1725

Crossref - DOI

Crossref - DOI Prefix: 10.18535/jmscr

Editorial Policy

Authors should prepare their manuscripts according to the instructions given in the authors' guidelines. Manuscripts which do not ..

Frequency of Publication

JMSCR is published as monthly journal with 12 issues per year. Special editions are also planned subjected to the scope and need....

Submission of Articles

Authors are invited to submit their research articles, review papers, Case Report properly formatted as per the author guidelines.........

Search