Thank you for this great summary of contemporary guidelines. I have had great luck placing a PENG and LFCN as soon as possible using liposomal bupivacaine with plain bupivacaine. Placing these blocksin the ED is best. Often this is effective for the patient's entire hospital stay with COX2 and acetaminophen. Placing a block earlier makes it so much easier to avoid hypotension with GA and delirium related to anesthetic doses required to maintain GA without a block. Thank you again!
My question is regard to high level units. I sometimes find us inconsistent in whether we keep our complex hips in a monitored bed overnight. We often use the PACU for this purpose. There was even a time that select patients would be moved to the PACU as they waited for surgery for optimization preop. Something that we have stopped. I imagine it was too demanding on staff / available beds. Anyone else keeping the elderly patient with a complex cardiac history, for example, in a monitored high dependency unit post op? (Or preop?)
This is a great question! I think that there is a role for pre-optimisation in a high dependency environment for some patients, and certainly, if their medical history is complex, nursing post-op in HDU can also be beneficial- we have done this in the past. The issue of course is bed availability
Thank you for a beautiful presentation! I also agree with your evidence and opinions. We believe that nerve block combined with SA/GA is a good option. Our centers are also prepared to operate promptly to perform surgery within 24 hours of admission. The current problem is that in our aging society, we are seeing an increasing number of fractures in very elderly patients (85-100 years old) with inferior cognitive function and with a significant decline in ambulatory function and ADLs. This is a severe problem; the challenge is managing the perioperative period and providing early recovery (they have significantly reduced function, to begin with).
Agreed 100 percent. Thanks for your positive comments. These issues are not going to go away sadly, so we will have to find a way to work around them I fear. Prompt intervention and early rehabilitation and remobilisation to at least baseline is one such target
As always, Amit, A great presentation. Lots of work obviously went into collecting everything together and it’s always a pleasure to listen to you. A comment and a question if I may: I find the expected prospect guidelines inclusion of nsaids to be interesting. As you mentioned previous guidelines try to stay away, and we’re talking about an elderly population often with already compromised renal function.
