Fractures of the proximal femur are of the most frequent, especially in elderly patients. The increased frequency of these fractures highlights the need for effective management of those patients and the impact of these fractures regarding the cost to the national health system. The effects of pain in elderly patients is extremely aggravating, frequently leading to mental (confusion, delirium) and physical (cardiovascular) deterioration and complications.
The pain management of these patients in the emergency department (ED) with intravenous administered analgesics might complicate the status of these patients. The use of non-steroidal anti-inflammatory drugs (NSAID’s) might increase the risk of gastric ulceration, gastric haemorrhage and coronary syndromes, while the use of IV opioids–especially in elderly-incorporates the risk of respiratory depression, delirium, hypotension and constipation. The pain management of these patients with the use of fascia iliaca block applied in ED, or even in a prehospital setting from doctors of various specialties, paramedics or nurses seems to gain acceptance because of its steep learning curve, the simple technique, the high success rate and the low rate of significant complications.Continue reading
This study compares the cardiovascular effects of spinal levobubivacaine or ropivacaine, in equipotent doses, for endoscopic urologic surgery. Eighty elderly, hypertensive patients, with physical status ASA I-III, scheduled to undergo transurethral procedures, were randomly allocated to receive spinal anesthesia with either 15 mg of levobupivacaine or 22.5mg of ropivacaine, in hyperbaric solutions.Continue reading