Anesthetic techniques and interventions
primary hip arthroplasty, fracture
After the patient was admitted to the operating room, the patient received an injection under the fascial iliaca in the supine position, which was performed by a designated physician. The patient was placed in the supine position under bedside ultrasound guidance using a high-frequency linear-array probe. After disinfection of the skin in the inguinal region and upper thigh, the ultrasound probe was placed horizontally just under the inguinal ligament lateral to the femoral artery. The fascia lata and fascia iliaca appeared as two hyperechoic lines. A 22-G puncture needle was inserted into the lateral thigh and 1 cm beyond the edge of the probe. The needle was inserted from the lateral side to the medial side, using an in-plane technique. The tip of the needle was passed through the fascia lata and then through the fascia iliaca. After puncturing the fascia iliaca and application of negative pressure suction, a pre-assigned solution was injected, which was 40 mL 0.5% ropivacaine for the FICB group and 40 ml saline for the control group. An expanding anechoic shadow between the fascia iliaca and the iliopsoas muscle served as a visual confirmation of the correct injection of the drug solution.Spinal anesthesia was performed 20 min after the completion of the drug injection. The patient was placed in the lateral position with the fracture side up. The intervertebral spaces between lumbar vertebrae L2-L3 and between lumbar vertebrae L3-L4 were located using ultrasound, and the anesthesiologists were free to select the appropriate intervertebral space for puncture. After confirming the free flow of cerebrospinal fluid, the intrathecal injection was performed using a 25-G spinal anesthesia needle with 1.5 to 2 mL of 0.5% isobaric bupivacaine. After administration of spinal anesthesia, the patient was changed to a supine position. Every one minute, the sensation was tested using a blunt-tipped needle, and anesthesia was considered adequate when the level of anesthesia reached T10. All subsequent surgical procedures were performed by three orthopedic surgeons with extensive experience in hip arthroplasty. As indicated by the hospital electronic medical record, all three participating orthopedic surgeons could routinely perform primary hip arthroplasty within 60–90 min, thereby ensuring the appropriateness of spinal anesthesia for the surgery.