Peripheral nerve block (Tetra block) - an effective alternative anesthesia for patients undergoing fractured femur neck surgery with recent myocardial infarction and low ejection fraction: a case report

Abstract

The fractured neck of the femur (NOF) is a common injury among the elderly population1 . Ischemic heart disease (IHD)is a common comorbid condition in these patients, and recent myocardial infarction (MI)adds a unique challenge for the anesthesiologist1 . The best timing for the surgery is known to be the day of admission or the day after admission. However, this poses a challenge due to patients possibly being on antiplatelet or anticoagulant therapy, which means central neuraxial blockade is not an option1 . General anesthesia (GA) for these patients can lead to cardiovascular and respiratory instability due to associated low ejection fraction (EF)2 . Hemodynamic fluctuations related to anesthesia can be harmful. In this case study, a patient with a NOF fracture and a recent MI with a low EF underwent hemiarthroplasty. The procedure used a peripheral nerve block (PNB) alongside sedation as the sole anesthetic technique. The patient remained stable throughout the surgery and in the postoperative period. Keywords: Neck of femur fracture, Myocardial Infarction, Peripheral Nerve Block, Tetra block, Locoregional, Ejection Fraction.