Open Reduction Internal Fixation (ORIF) – Trochanter

Anesthesia Implications

Position: Supine, one arm extended, other arm across chest
Time: 1-2 hours (average)
Blood Loss: Very High (500+ ml)
Post-op Pain: High (7-10)
Maintenance Paralytic: Yes
Lead: Yes

These patients are typically induced on the bed they come in with. They are then moved to the Hana table. A translucent drape will be put along the lateral side of the patient on the affected/surgical side.

Because of the location of the injury, a tourniquet is not an option. These surgeries can result in significant blood loss.

The patients having this procedure are typically elderly/fragile with multiple comorbidities. Paralytics are not necessary, but helpful to run the patient low on gases to preserve hemodynamics.

High Blood Loss (general considerations): Type and cross, CBC, and CMP should be done prior to the procedure. Consider having an A-line, blood tubing, and extra push-lines. Depending on the fragility of the patient, you may want to have blood in the room and available.

High post-operative pain (general considerations): Plan ahead to treat pain in the postoperative period. If not contraindicated, consider hydromorphone or other long-acting analgesics along with adjuncts such as Ofirmev and/or toradol. Where possible, give during the operative period to limit pain in the postoperative period. Where applicable, consider peripheral nerve blocks and/or epidural interventions.

Fluoroscopy / Xray (general considerations): Have lead aprons and thyroid shields available. Alternatively, distancing yourself 3 to 6 feet will reduce scatter radiation to 0.1% to 0.025% respectively. Occupational maximum exposure to radiation should be limited to a maximum average of 20 Sv (joules per kilogram – otherwise known as the Sievert/Sv) per year over a 5 year period. Limits should never exceed 50 Sv in a single year.