Safety of combined lumbar and sacral plexus block in high risk patients undergoing fractured neck of femur repair under general anaesthesia

Abstract

In this case series we present three high-risk patients with multiple co-morbidities listed for repair of fractured neck of femur with hemiarthroplasty under general anaesthesia. All three were administered combined unilateral lumbar plexus block (LPB) and sacral plexus block (SPB) for intra and post-operative analgesia. One patient presented with severe chronic obstructive pulmonary disease in combination with severe aortic stenosis. The second one had extensive medical history, was in fast atrial fibrillation (AF) and was actively taking clopidogrel. The last patient had an automatic implantable cardioverter defibrillator (AICD) for dilated cardiomyopathy secondary to ischaemic heart disease and was in left ventricular failure. All three patients had uneventful recovery and were discharged to the ward following their initial stay in the critical care unit. We discuss the evidence and controversies surrounding the techniques employed in these three difficult cases.