ABSTRACT
Five elderly women complicated with severe aortic stenosis were admitted to our hospital due to femoral neck fracture. Maximum aortic jet velocity was above 5.0 m · s(-1) and aortic valve pressure gradient was above 100 mmHg. Every family wanted to have the fractured femoral neck repaired, despite a high mortality during periop- erative period. We anesthetized the patients with com- bined lumbar plexus and sciatic nerve block and mild sedation. The operation was performed uneventfully. Although one of them sometimes complained chest pain during postoperative period, all five patients could be discharged without catastrophic events. The definition of severe aortic stenosis is above 4.0 m · s(-1) of maximum aortic jet velocity and below 1.0 cm(2) of aortic valve orifice area. As the severity of aor- tic stenosis, increases anesthetic management becomes more difficult and risky. To block the sympathetic nervous system only in the injured leg, we performed combined lumbar plexus and sciatic nerve block at the injured side. Circulatory disturbance was considered to be less than spinal anesthesia. Although the patients suffered from traction pain at the healthy leg and peri- neal region, this method could be chosen in cases of femoral neck fracture repair complicated with severe aortic stenosis.
