Combined lumbar plexus and sciatic nerve block for hip fracture surgery in a patient with severe aortic stenosis.

摘要

In the elderly population, the prevalence of symptomatic cardiac disease, including aortic stenosis, is increased. Despite impressive advances in anesthesiological and surgical techniques, morbidity and mortality in patients with severe aortic stenosis remains high [1]. Patients undergoing hip arthroplasty usually are elderly and present with different associated comorbidities [2]. We report successful management of a patient with aortic stenosis, hypertension, cerebrovascular disease, and a temporary pacemaker who underwent hip fracture surgery.A 75-year-old woman (60 kg, 155 cm) had fallen, resulting in a closed fracture of the right trochanter. She had cerebrovascular disease, aortic stenosis, and hypertension. Preoperative physical examination revealed findings consistent with her valvular heart disease and cardiac pulse of 35/min; the electrocardiogram showed complete atrioventricular (AV) block and left ventricular hypertrophy. A temporary pacemaker had been placed. The echo-cardiogram revealed an aortic valve area of 1 cm2 and concentric left ventricular hypertrophy. Aortic valve pressure gradient was 40 mmHg.