Locoregional anesthesia for injuries of the lower limbs
Barré, J.; Lefort, P.; Payen, M.
Cahiers d'Anesthesiologie 44(3): 197-201
1996
ISSN/ISBN: 0007-9685 PMID: 9005007 Document Number: 463103
Isolated lower limb injuries are very common; difficulties for emergency anaesthesia may come from full stomach and drug interferences. The outcome of geriatric-fractured hip is influenced neither by a preoperative delay shorter than 48 hours, nor by the choice of anaesthetic technique; Nevertheless the use of acrylic cement is associated with an increased early mortality rate in hemiarthroplasties. Regional anaesthesia is the best choice for stable patients with a limited peripheral injury; The technique must be adapted to the pain induced by fracture; sitting position is useful for puncture. Spinal anaesthesia using 0.5% plain bupivacaine produces a block quickly achieved, not influenced by posture, allowing surgical installation and procedures. Postoperative analgesia using local anaesthetics may obscure symptoms of compartment syndrome which occasionally complicate tibial and femoral nailing.