{
  "abstract": "Background and Aims Guidelines aiming to decrease morbidity and fatality in hip fracture patients recommend surgery within 24 to 48 hours of admission. In patients on antithrombotics, surgery is commonly delayed due to the cessation time required for spinal anesthesia. As a fascial plane block, the lumbar erector spinae plane block (L-ESPB) does not require antithrombotic cessation, allowing for prompt surgery. We report seven successful cases of femoral neck fracture repair under L-ESPB combined with sedation.Methods Seven patients (one male) on antithrombotics admitted to the hospital for femoral neck fracture repair consented to an L-ESPB as their primary anesthetic, to allow for surgery without delay. Our patients’ age ranged from 81 to 92 years, and their BMI from 22.9 to 32.4 kg/m2. Upon entrance to the OR, dexmedetomidine 1 μg/kg was infused in 10 minutes. The block was performed at the level of the 3rd lumbar transverse process under ultrasound guidance, with 40 mL of ropivacaine 0.5% and 5 μg/mL of adrenaline. Propofol 0.5 mg/kg/hr was continuously infused throughout surgery. All patients received a direct lateral or posterior approach cemented hemiarthroplasty.Results All patients were operated on within 24 hours of admission. Mean operation time was 57 minutes (45 to 95 minutes). Our patients remained sedated throughout surgery, without signs of pain (facial expressions, BP or HR rise), while maintaining spontaneous ventilation. Postoperative pain was controlled with 1 g of paracetamol at eight-hour intervals, and tramadol as a rescue analgesic. All patients were mobilized the day after surgery with full weight bearing as tolerated and discharged two days later.Conclusions The L-ESPB combined with sedation was safe and effective in providing surgical anesthesia in seven cases of femoral neck fracture surgery. Our cases warrant further investigation of this novel application of the L-ESPB as an alternative to spinal anesthesia in elderly hip fracture patients on antithrombotics.",
  "authors": [
    {
      "affiliations": [
        "Department of Anesthesiology, Athens Konstantopouleion General Hospital, Athens, Greece"
      ],
      "name": "Melina-Josephine Mccormac-Prekeze"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Athens Konstantopouleion General Hospital, Athens, Greece"
      ],
      "name": "Nikolaos Pentilas"
    },
    {
      "affiliations": [
        "Department of Anesthesiology, Athens Konstantopouleion General Hospital, Athens, Greece"
      ],
      "name": "Evangelia Mastrokosta"
    },
    {
      "affiliations": [
        "Department of Orthopedic Surgery, Athens Konstantopouleion General Hospital, Athens, Greece",
        "Department of Orthopedics, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Georgios Babis"
    },
    {
      "affiliations": [
        "Department of Orthopedic Surgery, Athens Konstantopouleion General Hospital, Athens, Greece",
        "Department of Orthopedics, Faculty of Medicine, National Kapodistrian University of Athens, Athens, Greece"
      ],
      "name": "Vassilios Nikolaou"
    }
  ],
  "title": "P248 Lumbar erector spinae plane block combined with sedation for surgical repair of femoral neck fracture in elderly patients on antithrombotics",
  "uid": "223f0637-96fe-50f2-aa77-956e52db7805"
}