Annually, 1 million hip fractures are diagnosed worldwide, with the highest incidence in North America and Europe [1]. Hip fractures in the elderly have a significant impact on life expectancy and quality, and are associated with a high incidence of respiratory, cardiac, and thrombotic complications. Surgical treatment, as well as treatment of perioperative pain, is often crucial in the survival of such patients, as it allows for early mobilization and reduces the incidence of complications associated with immobilization.
According to the authors, one third of such patients at rest have mild pain, one third - moderate pain and one third - severe pain [2]. Effective treatment of perioperative pain in such patients is associated with significantly better treatment outcomes: reduced duration of treatment and risks of delirium, early mobilization, less risk of respiratory and cardiac complications. For perioperative anesthesia in patients with fractures of the proximal thigh, the most common techniques are systemic analgesia, neuraxial (epidural) analgesia and peripheral nerve blocks - lumbar plexus blockade. Intraoperatively, respectively, anesthesia is provided by general anesthesia, neuraxial (spinal) anesthesia or compartment psoas block in combination with sciatic nerve block.
The effectiveness of systemic analgesia is often limited in this group of patients, due to the presence of contraindications (non-steroidal anti-inflammatory drugs (NSAIDs) or the development of side effects (respiratory depression and motility, nausea, sedation). hemodynamic complications (hypotension), which may lead to postoperative myocardial and renal damage, and limitations in patients already on anticoagulant or antiplatelet therapy. Psoas compartment block or lumbar posterior access block is a peripheral regional technique of anesthesia and analgesia, which provides anesthesia of the main components of the lumbar plexus - femoral, lateral cutaneous nerve of the thigh and sciatic nerve. In combination with the sciatic nerve block, the psoas compartment block provides effective anesthesia of the entire lower extremity, with better hemodynamic stability, compared to epidural anesthesia [3, 4]. The aim of the dissertation research was to improve the results of treatment of geriatric patients with fracture of the proximal thigh by optimizing the choice of anesthesia tactics in the perioperative period. To achieve this goal, the following research objectives were formed:
1. To determine the predictors of high-intensity postoperative pain in patients with a fracture of the proximal thigh.
2. To investigate the efficacy and safety of lumbar plexus blockade with catheterization of the perineural space for analgesia in the preoperative period.
3. To investigate the efficacy and safety of lumbar plexus blockade in combination with transgluteal sciatic nerve blockade in patients with a proximal femur fracture during surgery.
4. To investigate the efficacy and safety of lumbar plexus blockade with catheterization of the perineural space for analgesia in the postoperative period.
5. To investigate the influence of the type of anesthesia on the outcomes of treatment during surgery in patients with a proximal femur fracture.
6. On the basis of the received data to substantiate the concept of anesthesia of patients with a fracture of the proximal thigh and to develop an algorithm of anesthesia of these patients in the early post-traumatic period, during operations and in the postoperative period.
To solve these problems, two studies were conducted: prospective observational study of predictors of high-intensity postoperative pain and prospective controlled study of the effectiveness and safety of lumbar plexus blockade with catheterization of the perineural space for analgesia before, during and after surgery sciatic nerve intraoperatively. The study was conducted in the Department of Anesthesiology and Intensive Care of the Clinic "Into-Sana" (Odesa). The dissertation included patients of 7 study groups, divided into subgroups, depending on the tasks solved by each study.
