Bupivacaine hypobare dans l’anesthésie rachidienne continue pour fracture de la hanche du vieillard : Les effets hémodynamiques (Etude prospective randomisée)

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Olfa Kaabachi
Oussama Nasri
Khaireddine Raddaoui
Karima Zoghlami
Emna Trigui
Hassen Makhlouf

Résumé

Introduction : L’anesthésie rachidienne continue pour la chirurgie de la fracture de la hanche chez le sujet âgé préserve plus l’hémodynamique per opératoire comparativement à l’anesthésie  générale et à la rachianesthésie en injection unique. Mais, le risque de survenue d’une hypotension n’est jamais nul.


Objectif de l’étude était de montrer que la bupivacaïne hypobare dans la rachianesthésie continue préserve mieux l’hémodynamique comparativement à la bupivacaïne isobare.


Méthodes : Il s’agissait d’une étude prospective randomisée contrôlée en simple aveugle. Cent dix patients âgés de plus de 65 ans ont été randomisés pour recevoir de la bupivacaïne hypobare ou de la bupivacaïne isobare. Des doses répétées de 2,5 mg de bupivacaïne ont été injectées pour un bloc sensitif à T12. L’hypotension et l’hypotension sévère ont été définies comme une diminution de plus de 20% et de 30% de la pression artérielle systolique de base. L’analyse statistique a utilisé les tests Chi2 et Student pour comparer le nombre et le pourcentage ou la moyenne et la médiane. P<0,05 était significatif.


Résultats : Moins de patients ont présenté une hypotension et une hypotension sévère dans le groupe hypobare que dans le groupe isobare (respectivement 53 % contre 73 % ; p<0,05 et 22% contre 53 % ; p< 0,01). La consommation d’éphédrine était significativement plus faible dans le groupe bupivacaine hypobare (1.9 vs 5.6 mg; p<0,01).


Conclusion: La bupivacaïne hypobare est associée à une meilleure stabilité  hémodynamique dans la rachianesthésie titrée pour la chirurgie de la fracture de la hanche du sujet âgé.

Mots-clés :

Anesthésie Rachidienne , Bupivacaïne , Fracture de la hanche, Hypotension, Sujet âgé

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