Spinal Anesthesia for Hip Fracture Surgery in an Elderly Patient with Acute Hypertensive Lung Edema

Abstract

Luiz Eduardo Imbelloni and Joao Madruga

Background: Nowadays, fracture surgery represents a big part of the orthopedic surgeon workload, and usually has associated major clinical and social cost implications. We report a patient case of hip fracture with acute pulmonary edema treated with inguinal lumbar plexus block for analgesia and spinal anesthesia with low dose of isobaric bupivacaine for surgery.

Case Report: A 85-year-old female was admitted with fracture of the hip. Echocardiography was performed, which found respiratory auscultation with crepitates rules in both lungs, associated with blood pressure of 205x 108 mmHg. Chest radiographs showed a bilateral alveolar infiltrate. After discussion with the surgical team and family members, previous analgesia was proposed for lumbar plexus block via inguinal and spinal anesthesia with low dose of isobaric bupivacaine. The surgery lasted 110 min. In the PACU, the vital signs were blood pressure 140x73 mmHg, heart rate 80 bpm and with 98% oxygen saturation in the nasal catheter, and diuresis of 2,400 mL, as well as cardiac enzymes are normal. Received 200 mL of a drink with high energy and transferred to infirmary. The patient was discharged to her home on the third postoperative day asymptomatic.

Conclusions: The most important fact of this case is that the 85-years old patient with acute lung edema improved considerably after lumbar plexus block and spinal anesthesia with low doses and returned to her home on the third postoperative day

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