Hypobaric bupivacaine for continuous spinal anesthesia in elderly hip fracture: Effects on hemodynamic (A randomized controlled trial)

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Published Aug 24, 2023
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Vol. 101 No. 3 (2023): Tunis Med mars 2023

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Olfa Kaabachi
FMT - Institut kassab d'orthopédie
Oussama Nasri
université Tunis El Manar - institut kassab d'orthopédie
Khaireddine Raddaoui
université Tunis El Manar - institut kassab d'orthopédie
Karima Zoghlami
université Tunis El Manar - institut kassab d'orthopédie
Emna Trigui
université Tunis El Manar - institut kassab d'orthopédie
Hassen Makhlouf
université Tunis El Manar - institut kassab d'orthopédie

Abstract

Background: Continuous spinal anesthesia for surgical repair of hip fracture in elderly patients has been shown to preserve hemodynamics better than general and single shoot spinal anesthesia. However, hypotension still occurs, even with continuous spinal anesthesia.


Aim: This study aimed to demonstrate that hypobaric bupivacaine is more effective in preserving hemodynamics than isobaric bupivacaine when patients are operated in lateral position.


Methods: It was a prospective randomized controlled single-blind study conducted in an orthopaedic institute during two years (2017–2018). One hundred and ten patients aged more than 65 years, scheduled for hip fracture repair, were randomized to receive either hypobaric or isobaric bupivacaine. Repeated doses of 2.5 mg bupivacaine were injected until sensory blockade reached T12. Hypotension and severe hypotension were defined as a decrease of more than 20% and 30% from the baseline systolic arterial blood pressure and were treated with ephedrine. Statistical analysis used Chi2 and Student tests to compare either number and percentage or mean and median. P<0.05 was significant.


Results: Less patients experienced hypotension and severe hypotension in hypobaric group than in isobaric group (respectively 53% vs. 73%; p<0.05 and 22% vs. 53%; p< 0.01). Ephedrine consumption was significantly lower in hypobaric group (1.9 mg vs. 5.6 mg; p<0.01).


Conclusion: Hypobaric bupivacaine may be used rather than isobaric bupivacaine for further preserving hemodynamics in continuous spinal anesthesia for hip fracture surgery in elderly.

Keywords:

Elderly, Anesthesia, spinal, Bupivacaine, Hip fractures, Hypotension

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