ArticleMedical journal of the Islamic Republic of Iran2025
Use of Local Anesthesia Combined with Monitored Anesthesia Care in Cephalomedullary Nailing for Proximal Femoral Fractures: A Minimally Invasive Approach for High-Risk Surgical Candidates.
Article in Medical journal of the Islamic Republic of Iran, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Proximal femoral fractures are among the most common orthopedic injuries in the elderly population, and often pose serious challenges due to multiple comorbidities and the high anesthetic risk in this population. Traditional management typically involves spinal or general anesthesia, which can lead to considerable risk of morbidity and mortality in these high-risk patients. This study aimed to assess the efficacy and safety of local anesthesia combined with monitored anesthesia care as an alternative to general anesthesia in elderly patients with intertrochanteric fractures. Methods: In this retrospective descriptive study, we included patients aged ≥ 65 years with displaced intertrochanteric fractures who underwent cephalomedullary nailing under local anesthetic infiltration with monitored anesthesia care. Data were collected on demographics, safety outcomes (complications and mortality), and efficacy measures (surgical time, blood loss, anesthesia induction-to-incision time, and length of stay). Data were analyzed using descriptive statistics. Continuous variables are reported as mean ± standard deviation, and categorical variables as frequencies and percentages. No inferential statistics were performed because of the descriptive nature of the study. Results: A total of 35 patients met the inclusion criteria, with a mean age of 76.6 years. Major complications occurred in 6 patients (17.1%), with a 90-day mortality rate of 2.8%. "The mean blood loss was 108±35 cc, surgical time averaged 33.6±9.7 minutes, anesthesia induction-to-incision time was 6.4±1.7 minutes, and the mean length of hospital stay was 2±0.9 days." Conclusion: Local anesthesia with monitored anesthesia care may be a feasible and safe alternative for high-risk patients with proximal femur fractures when general or spinal anesthesia is contraindicated. This approach decreases morbidity and mortality rates while effectively reducing length of hospital stay and surgical time.
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