Combined lumbar and sacral plexus block compared with plain bupivacaine spinal anesthesia for hip fractures in the elderly

Background and Objectives: This prospective randomized study was designed C o determine the hemodynamic effects and quality of combined lumbar and sacr al plexus block compared with plain bupivacaine spinal anesthesia in the el derly for repair of proximal femoral fractures. Methods: Twenty-nine elderly patients ranging in age from 68 to 97 years we re randomly assigned to 2 groups: a spinal anesthesia group with single-sho t 3 mL 0.5% plain bupivacaine, and a combined black group with 30 mL lidoca ine 1.33% with epinephrine for the posterior lumbar plexus block and 10 mL same mixture for the parasacral block and an iliac crest block with 5 mL li docaine 1%. Results: No need for general anesthesia was encountered in either group. An esthesia was judged unsatisfactory in 1 of 15 patients in the combined bloc k group. The initial decrease of mean arterial pressure was 38% in the spin al group and 27% in the block group and was not significantly different. A more prolonged hemodynamic effect was found in the spinal group, indicated by the more frequent use ol: ephedrine to stabilize blood pressure (P < .05 ), Patients over 85 years had a significantly larger decrease in blood pres sure than younger patients (P < .01). Conclusions: Plain bupivacaine spinal anesthesia and combined lumbar/sacral plexus block provided adequate anesthesia for repair of hip fracture in th e elderly. Hypotension was induced by both the combined peripheral nerve bl ock and plain bupivacaine spinal anesthesia in aged patients; hypotension w as found to be longer lasting after spinal anesthesia and of a larger magni tude in patients over 85 years of age.