Acute and Critical Care

Original Articles

Trauma
Comparison of ropivacaine, bupivacaine, and lignocaine in femoral nerve block to position fracture femur patients for central neuraxial blockade in Indian population: Manik Seth, Santvana Kohli, Madhu Dayal, Arin Choudhury; Acute Crit Care. 2024;39(2):275-281. Published online May 30, 2024; DOI: https://doi.org/10.4266/acc.2023.01606

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Background
Patients with a fractured femur experience intense pain during positioning for neuraxial block for definitive surgery. Femoral nerve block (FNB) is therefore often given prior to positioning for analgesia. In our study, we compare the onset and quality of block of 0.25% bupivacaine, 0.5% ropivacaine, and 1.5% lignocaine for FNB in fracture femur patients.
Methods
Seventy-five adult femur fracture patients were equally and randomly divided into three groups to receive 15 ml of either 0.25% bupivacaine (group B), 0.5% ropivacaine (group R), or 1.5% lignocaine (group L) for FNB prior to positioning for neuraxial blockade. Onset and quality of block were assessed, as well as improvement in visual analog scale (VAS) score, ease of positioning, and patient satisfaction.
Results
Percentage decrease in VAS was found to be highest in group R (82.8%) followed by groups L and B. Time to achieve a VAS of less than 4 was found to be 26.2±2.4 minutes in group B, 8.5±1.9 minutes in group R, and 4.1±0.7 minutes in group L (P<0.001). In group B, 12 patients required additional fentanyl to achieve a VAS <4. Patient positioning was reported to be satisfactory in all patients in group R and L, while in B it was satisfactory in 13 (52%) patients only. Patient acceptance of FNB was 100% in group R and L, but only 64% in group B.
Conclusions
Based on our findings, 0.5% ropivacaine is a favorable choice for FNB due to early onset, ability to yield a good quality block, and good safety profile.

Citations

Citations to this article as recorded by

Concentration of local anesthetics is important in nerve blocks
Raghuraman M. Sethuraman
Acute and Critical Care.2025; 40(1): 150. CrossRef

Trauma
Elixhauser comorbidity measures-based risk factors associated with 30-day mortality in elderly population after femur fracture surgery: a propensity scorematched retrospective case-control study: Dohyung Kim, Hyunmin Jo, Younsuk Lee, Kyoung Ok Kim; Acute Crit Care. 2020;35(1):10-15. Published online February 29, 2020; DOI: https://doi.org/10.4266/acc.2019.00745

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Abstract PDF

Background
As the average life expectancy increases, anesthesiologists confront unique challenges in the perioperative care of elderly patients who have significant comorbidities. In this study, we evaluated Elixhauser comorbidity measures-based risk factors associated with 30day mortality in patients aged 66 years and older who underwent femur fracture surgery. Methods: We used the Medical Information Mart for Intensive Care III which contains the medical records of patients admitted to the intensive care unit (ICU) at Beth Israel Deaconess Medical Center in the United States between 2001 and 2012 to identify patients admitted to the ICU after femur fracture surgery (n=209). Patients who died within 30 days of admission (case group, n=49) were propensity score-matched to patients who did not (control group, n=98). The variables for matching were age, sex, race, anemia (hemoglobin ≤10 g/dl), and malignancy. We attempted to explain mortality via nine independent factors: hypertension, uncomplicated diabetes, complicated diabetes, congestive heart failure (CHF), cardiac arrhythmias, chronic pulmonary disease, renal failure, neurological disorders other than paralysis, and peripheral vascular disease. Results: Logistic regression identified three significant risk factors: CHF, arrhythmias, and neurological disorders other than paralysis. The odds ratio (OR) for the 30-day mortality of CHF was 4.99 (95% confidence interval [CI], 2.18 to 12.06). The equivalent ORs for cardiac arrhythmias and neurological disorders other than paralysis were 2.61 (95% CI, 1.14 to 6.21) and 2.40 (95% CI, 0.95 to 6.48), respectively. Conclusions: Identifying patients with these risk factors (CHF, arrhythmias, and neurological disorders other than paralysis) will assist clinicians with perioperative planning and provide caregivers with valuable information for decision-making.

Citations

Citations to this article as recorded by

A machine learning-based prediction model for in-hospital mortality among critically ill patients with hip fracture: An internal and external validated study
Mingxing Lei, Zhencan Han, Shengjie Wang, Tao Han, Shenyun Fang, Feng Lin, Tianlong Huang
Injury.2023; 54(2): 636. CrossRef
Complications and hospitalization costs in patients with hypothyroidism following total hip arthroplasty
Yuanyuan Huang, Yuzhi Huang, Yuhang Chen, Qinfeng Yang, Binyan Yin
Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
How age and gender influence proximal humerus fracture management in patients older than fifty years
Akshar H. Patel, J. Heath Wilder, Sione A. Ofa, Olivia C. Lee, Michael C. Iloanya, Felix H. Savoie, William F. Sherman
JSES International.2022; 6(2): 253. CrossRef
Comorbidity indices in orthopaedic surgery: a narrative review focused on hip and knee arthroplasty
SaTia T. Sinclair, Ahmed K. Emara, Melissa N. Orr, Kara M. McConaghy, Alison K. Klika, Nicolas S. Piuzzi
EFORT Open Reviews.2021; 6(8): 629. CrossRef

Case Report

Postoperative Unstable Angina Pectoris Occured in the Recovery Room: Case report: Myoung Oak Kim; Korean J Crit Care Med. 1999;14(1):52-57.

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Abstract PDF: The leading cause of death after anesthesia and operations is cardiac complications, defined as myocardial infarction, unstable angina, congestive heart failure. We experienced a case of transient chest pain mimicking to myocardial ischemia after total intravenous anesthesia using propofol. The patient was 56 year-old female who underwent metatarsal osteotomy and distal soft tissue procedure. There was no specific abnormality on preoperative laboratory tests. Anesthesia induction and intraoperative course were completely uneventful. Immediately after transfered to the recovery room, the patient revealed transient cyanosis and complained anterior chest pain with tightness after fully awakening. In the study of electrocardiogram, there were ST abnormality in II, III, AVF and then T inversion in II, III, AVL, AVF, V2-6 leads. In the simultaneous study of echocardiogram, there was hypokinetic wall movement in the distal septum area. After treatment of nitroglycerine, the pain was subsided and the patient was discharged without any sequelae.

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