BACKGROUND
One of the most important tasks in the work of an anesthesiologist is the choose the optimal method of anesthesiological support during surgery, especially in elderly patients with polymorbidity. In recent years, there has been an increasing introduction of regional methods of anesthesia, including prolonged analgesia, which allows to optimize the anesthesiological support of traumatic surgery, reduce the risk of perioperative complications, to eliminate or reduce the quantity of narcotic and non-narcotic analgesics used. The quality of an extended regional block depends on the reliability of fixation of a microcatheter pre-installed to the nerve trunk or plexus. Existing fixation methods do not always meet the criteria of reliability and safety.
DESCRIPTION OF THE CLINICAL CASE
The article describes a clinical case of anesthesiological support for surgical intervention in a fracture of the proximal femur in a long-lived patient with polymorbidity. Osteosynthesis of the subcutaneous fracture of the right hip was performed on the second day after hospitalization and within 24 hours after injury. The anesthesiological manual consisted of three regional methods of anesthesia: ileofascial block before positioning the patient on the operating table, low-dose spinal anesthesia for anesthetic support of surgical intervention and prolonged block of the femoral nerve to provide postoperative anesthesia. A catheter for the extended femoral nerve block was performed immediately after ileofascial block and fixed under the skin of the anterior abdominal wall in the hypogastric region according to the original technique developed by us.
RESULTS
This combination of regional anesthesia methods made it possible to create comfortable conditions for the patient during puncture of the subarachnoid space in a sitting position, perform surgery without hemodynamic and respiratory disorders, conduct long-term postoperative anesthesia without the use of narcotic analgesics and with a minimum amount of nonsteroidal anti-inflammatory medications, painlessly carry out mobilization measures and early activation of the patient and reduce the period of hospitalization to 9 days.
CONCLUSION
Optimization of anesthesiological support in the surgical treatment of a fracture of the proximal femur in a long-lived patient with polymorbidity in the form of ileofascial block, spinal anesthesia and prolonged postoperative block of the femoral nerve made it possible to ensure adequate analgesia/anesthesia in the perioperative period. With the method of fixation of the catheter for prolonged block of the femoral nerve under the skin of the hypogastric region, the catheter outlet to the skin was located far from the surgical intervention zone and the treatment area of the surgical field. During the block, there was no outward migration of the catheter, which allowed for high-quality postoperative regional anesthesia of the operated limb.