Abstract：
Proximal femur fractures have high rates of morbidity, mortality, and perioperative complications. Limiting anesthesia, especially in the elderly population, is a priority from a medical perspective. The goal of the current study is to present a technique of using local anesthetic with monitored anesthesia care (MAC) for the fixation of intertrochanteric (IT) femur fractures with cephalomedullary nailing (CMN), provide early clinical results in a small series of patients, and evaluate the safety, efficiency, and anesthetic efficacy of our technique.
The use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia.
Patients undergoing cephalomedullary nailing (CMN) with a long nail for IT femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi2, linear regression, and two-sampled T-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group.
Thirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions.
Local anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia.
III, therapeutic.
The use of only local anesthetic with MAC for the fixation of IT fractures is safe and leads to decreased operative times when compared to spinal and general anesthesia.
Patients undergoing cephalomedullary nailing (CMN) with a long nail for IT femur fractures by a single surgeon from January 2020 to June 2021 were identified retrospectively from a prospectively-collected patient registry. Patient demographics, operative time, length of hospital stay, perioperative medication use, and complications were collected. Analysis of variance, Chi2, linear regression, and two-sampled T-tests were performed to analyze potential differences between the local anesthesia group and the general or spinal anesthesia group.
Thirty-seven patients were identified. Eleven patients underwent CMN using local anesthesia with MAC, 11 using spinal anesthesia, and 15 using general anesthesia. The local anesthesia group demonstrated significantly lower operating room times and anesthesia induction to incision time compared to other anesthesia techniques. The local anesthesia group also trended towards less need for vasopressors during surgery and less postoperative delirium. No differences were identified in intraoperative narcotic use, complications, patient mortality, or hospital readmissions.
Local anesthesia with MAC for the treatment of IT fractures with CMN was associated with decreased operating room times and had similar complication rates including blood transfusions, readmissions, and mortalities, when compared to spinal and general anesthesia.
III, therapeutic.
摘要：
背景：股骨近端骨折的发病率高，死亡率,围手术期并发症。限制麻醉，尤其是老年人口，从医学角度来看是优先考虑的。本研究的目的是提出一种使用局部麻醉药和监测麻醉护理（MAC）的技术，用于股骨粗隆间（IT）骨折的固定与头髓内钉（CMN），在一小部分患者中提供早期临床结果，并评估安全性，效率,以及我们技术的麻醉效果。
目的：与脊髓和全身麻醉相比，仅使用局部麻醉药和MAC固定IT骨折是安全的，并且可以减少手术时间。
方法：从2020年1月至2021年6月，由一名外科医生进行头髓髓内钉（CMN）长钉治疗股骨粗隆间（IT）骨折的患者从前瞻性收集的患者注册表中进行回顾性鉴定。患者人口统计学，手术时间,住院时间,围手术期用药,收集并发症。方差分析，卡方，线性回归，并进行了两次采样T检验,以分析局部麻醉组与全身麻醉或脊髓麻醉组之间的潜在差异.
结果：确定了37例患者。11例患者使用MAC局部麻醉进行CMN，11使用脊髓麻醉，和15使用全身麻醉。与其他麻醉技术相比，局部麻醉组显示出明显更低的手术室时间和麻醉诱导至切口时间。局部麻醉组也倾向于在手术过程中对血管加压药的需求减少和术后谵妄减少。术中麻醉使用没有差异，并发症,患者死亡率,或者再入院.
结论：用MAC局部麻醉治疗CMN治疗IT骨折与减少手术室时间相关，包括输血在内的并发症发生率相似，再入院,和死亡率，与脊髓和全身麻醉相比。
方法：III,治疗性。
目的：与脊髓和全身麻醉相比，仅使用局部麻醉药和MAC固定IT骨折是安全的，并且可以减少手术时间。
方法：从2020年1月至2021年6月，由一名外科医生进行头髓髓内钉（CMN）长钉治疗股骨粗隆间（IT）骨折的患者从前瞻性收集的患者注册表中进行回顾性鉴定。患者人口统计学，手术时间,住院时间,围手术期用药,收集并发症。方差分析，卡方，线性回归，并进行了两次采样T检验,以分析局部麻醉组与全身麻醉或脊髓麻醉组之间的潜在差异.
结果：确定了37例患者。11例患者使用MAC局部麻醉进行CMN，11使用脊髓麻醉，和15使用全身麻醉。与其他麻醉技术相比，局部麻醉组显示出明显更低的手术室时间和麻醉诱导至切口时间。局部麻醉组也倾向于在手术过程中对血管加压药的需求减少和术后谵妄减少。术中麻醉使用没有差异，并发症,患者死亡率,或者再入院.
结论：用MAC局部麻醉治疗CMN治疗IT骨折与减少手术室时间相关，包括输血在内的并发症发生率相似，再入院,和死亡率，与脊髓和全身麻醉相比。
方法：III,治疗性。
