title: Hip hemiarthroplasty using major lower limb nerve blocks: A preliminary report of a case series.
abstract: BACKGROUND
  Major lower limb nerve blocks are relatively safe techniques. However, their efficacy for hip hemiarthroplasty is unknown. The objective of this study was to determine the effectiveness of combined femoral, sciatic, obturator and lateral femoral cutaneous (LFC) nerve blocks in providing adequate anesthesia for hip hemiarthroplasty.
  
  
  METHODS
  A total of 20 patients with fracture neck femur; who underwent hip hemiarthroplasty, participated in this observational study. In the induction room, all patients received ultrasound-guided femoral, proximal obturator, LFC and parasacral sciatic nerve blocks in addition to local infiltration at the proximal site of the skin incision. Anesthesia was considered to be adequate only if the surgery was completed without any requirement for opioid administration.
  
  
  RESULTS
  All patients (100% [95% confidence interval, 86-100%]) had adequate anesthesia. Seventeen patients (85% [95% confidence interval, 63-96%] had mild discomfort during the reduction of the prosthetic femur head back into the hip socket; however, no supplementary analgesics were required.
  
  
  CONCLUSIONS
  The combined femoral, sciatic, obturator and LFC nerve blocks in addition to local infiltration at the proximal site of skin incision could provide adequate anesthesia for hip hemiarthroplasty. Light sedation before reduction of the prosthetic femur head back into the hip socket is advisable.
authors.affiliation: Department of Anesthesia, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Ahmad Muhammad
authors.initials: AM
authors.lastname: Taha
authors.affiliation: Department of Anesthesia, Ain Shams University, Abbasia, Cairo, Egypt.
authors.forename: Mohammed Abd-Elfttah
authors.initials: MA
authors.lastname: Ghoneim
keywords: Anesthetics local; anesthetic techniques; bupivacaine; equipment; femoral; regional; ultrasound machines