Combined Spinal-epidural Anesthesia for Hip Fracture Surgery in Two Geriatric Patients with Low Ejection Fractions

Aims: To present the combined spinal-epidural anesthesia and postoperative analgesia in two geriatric patients, with low Ejection Fractions (EF) that underwent hip fracture surgery.

Presentation of Case: Herein, 90 and 106-years-old geriatric patients respectively, with low ejection fractions were admitted to the orthopaedic ward because of hip fracture. These patients were planned to undergo hip prosthesis surgery. Anesthesia and postoperative analgesia were achieved by Combined Spinal-Epidural (CSE) techniques in both patients. We observed that spinal anesthesia using low dose hyperbaric bupivacaine with fentanyl was an effective and safe method, and post-surgical patient controlled analgesia via an epidural catheter provided sufficient pain control for 48 h.

Discussion: In older patients with hip fracture, comorbidities such as cardiac disease increase the risk of perioperative morbidity and mortality. Individuals that undergo hip prosthesis surgery are usually geriatric patients, and comorbidities can increase their risk of perioperative morbidity and mortality during surgery. Regional anaesthesia techniques are widely utilized for surgical procedures (especially obstetrics, orthopaedics, urology, general surgery) and pain management, and they are known to have favourable effects on the vital signs and endocrine and metabolic responses after the operation compared with those of general anesthesia. In addition, regional anaesthesia is preferable because of its superior results in relation to postoperative pain control.

Conclusion: Combined spinal epidural anaesthesia with low-dose hyperbaric bupivacaine and fentanyl in hip fracture surgery is a safe and efficient method when used in geriatric patients with low EF. In addition, we find that patient controlled epidural analgesia is a considerably effective technique in postoperative pain management.