title: Combined Fascia Iliaca and Sciatic Nerve Block for Hip Surgery in the Presence of Severe Ankylosing Spondylitis: A Case-Based Literature Review.
abstract: OBJECTIVE
  Selecting an appropriate anesthetic technique for patients with ankylosing spondylitis undergoing hip surgery is challenging because of a potentially difficult airway, the risk of cardiovascular and respiratory complications, and the technical difficulty of performing central neuraxial blocks in patients with ankylosing spondylitis. Our objective was to report a case in which combination neural blockade was used successfully in an elderly patient with ankylosing spondylitis undergoing hip fracture surgery. In addition, a literature review of the anesthetic techniques reported for these patients was conducted.
  
  
  METHODS
  A 70-year-old man with severe ankylosing spondylitis and respiratory dysfunction was scheduled for a closed intertrochanteric fracture reduction and internal fixation. Combined fascia iliaca block and parasacral sciatic nerve block were used successfully for the surgery. Postoperative analgesia was accomplished by continuous fascia iliaca block.
  
  
  CONCLUSIONS
  According to the literature review, general anesthesia is the most commonly performed anesthetic technique for patients with ankylosing spondylitis undergoing hip surgeries. Special intubation techniques and cautious airway management were very important for these patients. Although both general anesthesia and central neuraxial blockade pose considerable risks to the patients, this case report suggests that combined fascia iliaca block and sciatic nerve block might be a promising option.
authors.affiliation: From the Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.
authors.forename: Lingmin
authors.initials: L
authors.lastname: Chen
authors.forename: Jin
authors.initials: J
authors.lastname: Liu
authors.forename: Jing
authors.initials: J
authors.lastname: Yang
authors.forename: Yanzi
authors.initials: Y
authors.lastname: Zhang
authors.forename: Yue
authors.initials: Y
authors.lastname: Liu
mesh_terms: D000368:Aged; D005205:Fascia; D006620:Hip Fractures / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D009407:Nerve Block / Q000379:methods*; D012584:Sciatic Nerve; D012720:Severity of Illness Index; D013167:Spondylitis, Ankylosing / Q000150:complications / Q000175:diagnosis / Q000601:surgery*