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49th Annual Regional Anesthesiology and Acute Pain Medicine Meeting
March 21-23, 2024 | The Hilton Bayfront San Diego | San Diego, California
5521
INITIATION OF FRAGILITY FRACTURE PROTOCOL TO IMPROVE PERIOPERATIVE OUTCOMES IN ORTHOPEDIC ONCOLOGY
Poster Presenter
Authors
Affiliations
Part of Topic
Medically Challenging Cases
INTRODUCTION
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Orthopedic fractures are common in elderly patients, especially with oncologic malignancies
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Pain management is challenging: comorbidities, risk of cognitive dysfunction, opioid tolerance with chronic pain
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We aimed to develop a protocol to standardize pain management of acute oncologic fracture patients, with regional anesthesia interventions as a primary component
METHODS
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Highlight two clinical cases that involved comprehensive perioperative care with regional anesthesia for oncologic extremity fractures
CASE REPORT - 1
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79 year-old woman with RCC →femoral neck fracture
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Initial management with oral/IV opioids was unsuccessful and results in significant delirium
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Acute pain consulted → s/p PENG x 2 + LFCN block (Fig. 1)
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Opioid consumption decreased by 60% in preop and postop period compared initial presentation
CASE REPORT - 2
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83 year-old woman with metastatic urothelial carcinoma → pathologic tibial fracture with 10/10 pain in ED
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Acute pain consulted → anterior sciatic and femoral nerve block catheters
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Pain 10/10 →0-2/10 with minimal perioperative opioid use
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Catheters removed on POD2 prior to discharge
DISCUSSION
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Regional anesthesia is an effective strategy for perioperative analgesia in the setting of orthopedic oncology fractures
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Regional interventions minimize complications associated with opioid consumption in at-risk patient population
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Establishing a multidisciplinary protocol ensures that patients are offered access to regional anesthesia strategies for perioperative pain relief