Phối hợp phong bế đa thần kinh ngoại vi với gây mê mask thanh quản cho bệnh nhân phẫu thuật thay khớp háng nguy cơ rất cao: Báo cáo ca lâm sàng

Abstract

Total hip arthroplasty in a patient with severe pulmonary hypertension, heart failure, and end-stage renal disease on hemodialysis is a major anesthetic challenge due to the high mortality risk with both standard general anesthesia and neuraxial anesthesia. We report a 64-year-old male (50 kg, ASA IV) with a right femoral neck fracture, left ventricular ejection fraction 31%, right ventricular fractional area change 28%, systolic pulmonary arterial pressure 79 mmHg, and end-stage renal disease on hemodialysis. The patient underwent total hip arthroplasty via a posterolateral approach. The anesthetic strategy strictly avoided neuraxial techniques, substituting them with four ultrasound-guided peripheral nerve blocks (femoral, anterior and posterior obturator, lateral femoral cutaneous, and sacral multifidus plane blocks) using 110 mg of 0.25% ropivacaine mixed with dexamethasone. This was combined with BIS-guided general anesthesia via a laryngeal mask airway, prophylactic noradrenaline, and sugammadex. Intraoperative hemodynamics remained stable. Postoperatively, the patient recovered smoothly, maintaining a Visual Analog Scale (VAS) pain score of 1/10 for 12 hours without requiring supplemental opioids. This approach demonstrates a feasible and safe anesthetic strategy for high-risk patients.