#NOF - your prefered technique?

[deleted59964]

---

Members don't see this ad.

how do you guys do these?

GA unless good reason for spinal
spinal unless good reason for GA
if spinal how do you analgese for positioning?
fentanyl, ketamine, femoral nerve block?

thanks

 

[urge]

no clue what #nof means.

PS: Your avatar makes me happy.

 

[Orin]

no clue what #nof means.

PS: Your avatar makes me happy.

http://www.ozemedicine.com/wiki/doku.php?id=nof
"fracture neck of femur (#NOF)"

PS: I concur.

 

[deleted59964]

well i have to have something keep people's interest when I'm talking about fractured neck of femurs, and competing with "spraying the walls red".

 

[W222]

Are we simply talking a pinning? If so then spinal if the patient is ok with it, the surgeon is competent, and we can position them. It also gives the opportunity to give intrathecal opiate to provide some prolonged pain relief. Even with a busted hip most patients can be turned/rolled for a spinal, it's easier the older they are cause a little fentanyl goes a long way.

 

[pgg]

how do you guys do these?

GA unless good reason for spinal
spinal unless good reason for GA
if spinal how do you analgese for positioning?
fentanyl, ketamine, femoral nerve block?

thanks

Obviously depends on the patient. But my default technique is a fascia iliaca block and GA with LMA vs ETT. I like not having to move the patient to do a spinal, and I like the super short PACU stays after GA.

When I do spinals I usually use a bit of ketamine for positioning.

 

[Idiopathic]

p/s/t

 

[deleted59964]

Are we simply talking a pinning?

yes i meant for pinning

spinal seems like it should cause less delirium
but if you give fentanyl or ketamine for positioning - do you lose that advantage?

i've heard others do a femoral nerve block (or fascia iliac) pre spinal - this seems like it should help if you don't need systemic analgesia to position - i haven't tried it (yet).

have others had successful pain free positioning for spinal after femoral nerve block alone?

 

[Planktonmd]

yes i meant for pinning

spinal seems like it should cause less delirium
but if you give fentanyl or ketamine for positioning - do you lose that advantage?

i've heard others do a femoral nerve block (or fascia iliac) pre spinal - this seems like it should help if you don't need systemic analgesia to position - i haven't tried it (yet).

have others had successful pain free positioning for spinal after femoral nerve block alone?

GA+ LMA most of the time.
Fascia iliaca block if they are in too much pain post-op, occasionally pre-op
I live by the principal of KISS!

 

[Pooh & Annie]

Single shot femoral. Propofol for positioning. Iso/hypobaric bupi (0.5%) with fractured side up. If SAB is contraindicated or patient doesn't want it, GA is fine too