Hemiarthroplasty in high risk elderly patient under epidural anesthesia with 0.75% ropivacaine-fentanyl versus 0.5% bupivacaine-fentanyl: Clinical trial

Abstract

Background:Anesthetic management of elderly patients is a challenge as aging makes them more susceptible to hemodynamic fluctuations during regional anesthesia. This study was aimed to compare the clinical efficacy of epidural 0.75% ropivacaine fentanyl (RF)– with 0.5% bupivacaine–fentanyl (BF) for hemiarthroplasty in high-risk elderly patients.Methods:Sixty elderly consented patients of either sex with American Society of Anesthesiologist ASA II and III, scheduled for elective hemiarthroplasty were randomized into two Groups of 30 patients to receive epidural study solution of 15 mL of 0.75% Ropivacaine or 0.5% Bupivacaine with 1 mL fentanyl (50 μg). The hemodynamic variability with onset and duration of sensory and motor blocks were recorded. The adequacy and quality of surgical anesthesia were assessed. The post-epidural nausea and vomiting, shivering, respiratory parameters, or any other side effects were also recorded.Results:There was no difference in the demographic profile between groups. The mean onset time to achieve sensory block to the T10 dermatome was rapid in the Group BF (12.4±6.9 vs. 17.5±3.7 min in Group RF). The mean time to achieve motor block was 17.5±3.4 min in Group BF versus 21.7±7.8 min in Group RF. The intraoperative hemodynamic fluctuations showed statistically significant differences between groups. The pruritis was observed in five patients but post-epidural shivering, nausea, vomiting, respiratory depression, or urinary retention were not observed in any patient.Conclusion:Epidural 0.75% Ropivacaine with fentanyl showed better clinical profile as compared to 0.5% Bupivacaine with fentanyl for hemiarthroplasty in elderly patients.

A Clinical Comparative Study between Fentanyl and Dexmeditomidine as an Adjuvant with 0.75% Ropivacaine in Epidural Anaesthesia for Lower Limb Orthopaedic Surgery

“…Also Bajwaet al 8 and Kamal, M. M. and Talaat, S. M. 17 found in their study that dry mouth was more common with epidural dexmedetomidine which we also found in our study. Also Selim MF et al 2 and Gupta et al 9 in their study foundthat the incidence of nausea and vomiting was higher in the fentanyl group than dexmedetomidine group, when given epidural injection which is in accordance to our findings. Similarly,Hanoura S, Hassanin R and Singh R. 18 and Bamne et al 16 in their study did not found any significant side effects by the addition of epidural dexmedetomidine and fentanyl.…”

“…Table 21 shows the spo2 of both the groups. Appropriate statistical test shows that there was no significant difference in the above parameter in the two study groups, which corroborates with the findings of Oriol Lopez SA et al 15 , J. Carreon, et al 7 , Bajwaet al 8 , Yongxin Liang, et al 19 , Selim MF et al 2 , Gupta et al 9 , Negi S et al 14 and Bamne et al 16…”

“…Also Selim MF, et al 2 in their study did a comparative evaluation of epidural dexmedetomidine and fentanyl with bupivacaine and found that the number of patients with a sedation score of 2 was significantly higher in the dexmedetomidine group compared with the fentanyl group. Similarly Gupta et al 9 in their comparative study between adjuvants dexmedetomidine and fentanyl with epidural 0.5% levobupivacaine for vaginal hysterectomy found that, the maximum ramsay sedation score was higher (>3) in the patients belonging to the dexmedetomidine group, while it was less than 2 in the fentanyl group. Similar results were also found in our study, with dexmedetomidine group showing higher ramsay sedation scores >2 than fentanyl≤2.…”

“…And the mean time for regression to B1 for the group RD was 259.62 ± 21.38 min and that for the group RF was 178.52 ± 23.29 min, which is similar to our study. Also Gupta et al 9 found that, epidural dexmedetomidine and fentanyl when compared as an adjuvants with other local anaesthesia like 0.5% levobupivacaine, the time taken to reach complete motor block is early and duration of motor block (167.4 ± 21 min) is prolonged in the dexmedetomidine group than the fentanyl group, (125.6±36 min) which is statistically significant. So all of the above studies found that the time taken for complete motor block in the dexmedetomidine group was earlier in comparison to the fentanyl group.…”

“…Also the local anesthesia used in their study was bupivacaine which is more potent than ropivacaine. Also, Gupta et al 9 in their comparative study ofboth epidural dexmedetomidine and fentanyl for vaginal hysterectomy, found that there was decline in the heart rate and mean arterial pressure in both the groups and maximum decline was seen at 30-35 mins. And they concluded that hemodynamic stability was one of the most remarkable features with addition of dexmedetomidine and fentanyl which we also found in our study.…”