Monitored Anesthesia Care and Soft-Tissue Infiltration With Local Anesthesia: An Anesthetic Option for High-Risk Patients With Hip Fractures.

Abstract

OBJECTIVES:

To examine the feasibility of a novel anesthetic option for hip fracture fixation with short cephalomedullary nails.

DESIGN:

Retrospective cohort study.

SETTING:

The study setting involved an urban, academic Level 1 trauma center, a tertiary care academic medical center, and an orthopaedic specialty hospital.

PATIENTS/PARTICIPANTS:

Twenty recent and 40 risk-matched (1:1:1 by anesthesia type) historical hip fracture patients were included in the study.

INTERVENTION:

All patients with an OTA/AO 31.A1-3 intertrochanteric hip fracture presenting from October 1, 2019 to March 31, 2020 treated with a short cephalomedullary nail underwent a new intraoperative anesthesia protocol using monitored anesthesia care (MAC) and soft-tissue infiltration with local anesthesia (STILA).

MAIN OUTCOME MEASUREMENTS:

Intraoperative measures, postoperative pain scores, narcotic and acetaminophen use, hospital quality measures, and inpatient cost.

RESULTS:

A total of 60 patients (20 each: MAC, general, and spinal) were identified. There were differences among the groups regarding mean minimum and maximum intraoperative heart rate with MAC-STILA protocol demonstrating the best maintenance of normal heart rate parameters (60-100 beats per minute). For the first 3 hours postoperatively, MAC-STILA patients reported consistently lower pain scores (visual analog scale <1) than spinal or general patients (visual analog scale > 1). Through 48 hours postoperatively, MAC-STILA narcotic usage was similar to that of the spinal cohort and approximately 5 times less than the general cohort. There were no differences in procedural time, length of stay, minor or major complications, inpatient and 30-day mortality, or 30-day readmissions, or postoperative ambulatory distance. There was no difference in inpatient cost among cohorts.

CONCLUSIONS:

This feasibility study demonstrates safety for the MAC-STILA protocol with comparison to spinal and general anesthesia. The MAC-STILA protocol is a viable option for treatment of OTA/AO 13.A1-3 intertrochanteric fractures with a short cephalomedullary nail and may be the preferred method for patients with severe medical comorbidities or relative contraindications to general and/or spinal anesthesia.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of Levels of Evidence.

• Authors: Sanjit R Konda, Rachel A Ranson, Nicket Dedhia, Yixuan Tong, Evens Saint-Cyrus, Abhishek Ganta, Kenneth A Egol
• Journal: Journal of orthopaedic trauma (J Orthop Trauma) Vol. 35 Issue 10 Pg. 542-549 (Oct 01 2021) ISSN: 1531-2291 [Electronic] United States
• PMID: 33967226 (Publication Type: Journal Article)
• Copyright: Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

Chemical References

• Anesthetics

Topics

• Anesthesia, Local
• Anesthetics
• Bone Nails
• Fracture Fixation, Intramedullary
• Hip Fractures (surgery)
• Humans
• Retrospective Studies
• Treatment Outcome