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.
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