Different anesthesia methods, including general and regional anesthesia, are used in
operating rooms in daily practice. When general anesthesia is performed, the patient is
rendered entirely unconscious by using intravenous and/or inhalation anesthetics, total
sensory loss develops, and the patient's ventilation is provided by a mechanical
ventilator. Regional anesthesia applications consist of blockage of nerve conduction by
applying local anesthetics from different body parts without causing loss of
consciousness. By using neuraxial anesthesia techniques - such as spinal anesthesia,
epidural anesthesia, and caudal block - medulla spinalis-related neuronal blocking can be
performed. Another regional anesthesia method whose use has expanded considerably in
recent years is peripheral nerve blocks. This anesthesia method injects local anesthetic
by targeting a specific plexus, nerve, or facia without any central nervous system
blockage.
An essential part of intraoperative anesthesia management is planning analgesia for
postoperative pain. It is aimed to provide analgesia with intravenous analgesics, central
neuraxial blocks, or peripheral nerve blocks. Ensuring postoperative pain management has
great importance in clinical practice because pain is associated with the patient's
superficial breathing, prolonged immobilization, and noncompliant patients. Therefore, it
is related to the development of atelectasis in the postoperative period and/or
hypoxia-hypercarbia caused by inadequate gas exchange. In this situation where the
patient cannot provide adequate respiration, the need for noninvasive mechanical
ventilation may develop in the ward or intensive care unit where the patient is followed,
closer clinical follow-up will be required, and the patient's hospitalization period will
be prolonged. For this reason, it is one of the primary responsibilities to prefer
anesthetic methods that help to provide optimal postoperative pain management.
Femoral fracture cases are primarily encountered in elderly patients with multiple
comorbidities. Postoperative follow-up of these highly mortal fractures is often provided
in intensive care units. In Turkish society, with an increasing elderly population, the
long hospitalization periods of this patient group in the intensive care unit and their
subsequent follow-up in the ward until they are discharged bring high healthcare costs.
It has been shown in various studies in the literature that the anesthetic method is
related to the length of hospitalization. Therefore, the clinical practices of
anesthesiologists who frequently work with elderly patients in the operating room and
intensive care are essential.
The clinician chooses the method of anesthesia, taking into account the type of
operation, contraindications of the patient's clinical condition, pain management,
postoperative follow-up conditions, and patient request. In critically ill patients with
femoral fractures, the surgical procedure is successfully performed under general
anesthesia, spinal anesthesia, or lumbar erector spinae plane (ESP) block. There are
studies in which erector spinae plane (ESP) block applied from the lumbar region has been
used as a primary anesthetic method that allows surgery in patients with femoral
fractures.
In this study, the investigators aimed to compare the regional anesthetic methods (not
including general anesthesia) -spinal anesthesia, erector spinae plane (ESP) block- which
are in routine practice in critically ill adult patients operated for femur fracture in
terms of intraoperative and postoperative hemodynamics and clinical course, postoperative
intensive care unit stay and hospitalization durations, pain scores, postoperative
morbidity, and mortality.