Femoral and femoral cutaneous ultrasound guided nerve block as an anesthesic technique for hip fracture, intertrochanteric and non-displaced subcapital fractures: review of 10 cases.

Background:
Hip fractures are typically seen in elder patients with high-risk surgery and multiple co-morbilities  as coagulopaty, head and brain trauma or respiratory infections.
Those patients would benefit from alternative anesthetic techniques like femoral with femoral cutaneous ultrasound (US)-guided nerve block in intertrochanteric femoral fractures and non-displaced subcapital fractures, where cannulated nail are used, not being as beneficial in other types of fractures such as displaced subcapital ones where a hip replacement is needed .
Materials and Methods:
The records of 10 patients who had undergone surgery due to an intertrochanteric femoral fracture or a non-displaced subcapital fracture performed with a femoral and femoral cutaneous US-guided nerve block were evaluated. We reviewed the main demographic characteristics, indications, cogulation, and outcomes of this anesthesic technique.
Results:
Among the ten patients the average age was 87 years old, there where no difference between male and female, 5 patients each. Eight patients had a intertochanteric femoral fracture and two a non-displaced subcapital fracture, all of them treated with cannulated nail. Six of them were classified in the ASA physical status classification system as ASA III and three of them as ASA IV, only one was ASA II. Coagulopaty was seen in 3 of them with an INR above 1.4, and two patients were anticoagulated with new anticoagulants that couldn´t be suspended before the surgery because of the lack of time.  Seven patients undergone sedation during the procedure and there were no conversion into general anesthesia nor technical complications after the US guided nerve block.   
Conclusion(s):
we conclude that US-guided femoral and femoral cutaneous nerve block is a safe and easy procedure than can be performed in patients with high-risk surgery were neuroaxial or general anesthesia have more associated co-morbilities.

03 / Femoral and femoral cutaneous ultrasound guided nerve block as an anesthesic technique for hip fracture, intertrochanteric and non-displaced subcapital fractures: review of 10 cases._x000B_