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Blocs peripheriques chez un patient de 48 ans avec stenose aortique severe pour reduc fracture hanche

The potential advantages of 0.25% concentration of levobupivacaine in performing lumbar plexus with sciatic and iliohypogastric nerve block in patients with aortic stenosis is emphasized in this case report. A 48-yr old male patient who was scheduled for hip fracture surgery had severe aortic stenosis with aortic valve gradient of 85 mmHg. Anesthesia plan was combined lumbar plexus, sciatic and iliohypogastric nerve block with a total of 60 mL, 0.25% levobupivacaine. After performing the blocks, the patient underwent successful and uneventful hip reduction surgery except requiring only sedation medications. The patient had sufficient anesthesia and remained hemodynamically stable without the use of vasoconstrictive medication during the operation. We thought that combined lumbar plexus, sciatic and iliohypogastric nerve block with 0.25% levobupivacaine provides stable hemodynamic parameters with adequate anesthesia for hip fracture surgery in patient with severe aortic stenosis.

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Systemic Lidocaine Decreased the Perioperative Opioid Analgesic Requirements but Failed to Reduce Discharge Time After Ambulatory Surgery

Perioperative systemic lidocaine significantly reduces opioid requirements in the ambulatory setting without affecting time to discharge. Postoperative pain is the most common reason for delay in discharge and unplanned hospital admission after ambulatory surgery. 1–3 Because postoperative pain is to a large extent an inflammatory phenomenon, administration of systemic local anesthetics, which have inflammatory modulatory properties, 4 could significantly reduce pain and therefore allow more rapid discharge. 5 Lidocaine has an excellent safety record when administered by low-dose infusion. 5–7 However, whereas decreased hospital stay after inpatient surgery has been demonstrated, the effect of intraoperative and early postoperative lidocaine infusion on duration of stay after ambulatory surgery is not known. Although it see...