Low-dose spinal block for hip surgery: A systematic review

Almeida, Carlos Rodrigues; Cunha, Pedro; Vieira, Lígia; Gomes, Ana Rita

doi:10.1016/j.tacc.2022.06.004

“…Modified regional techniques have been proposed in high-risk cardiac patients to reduce the haemodynamic impact of the standard dose single-shot spinal anaesthesia; nevertheless, titrated neuraxial techniques that attempt to minimise hypotension, such as continuous spinal anaesthesia, may lead to significant vasopressor consumption. [ 1 ] The current study describes a novel approach for hip fracture surgery using the deep fascia iliaca (DeFI) block combined with the sacral plexus block. The primary objective of this case series was to demonstrate the reliability of the anaesthetic approach (including haemodynamic stability, complaints during the procedure, and differences in the numerical pain rating scale [NPRS] between the preoperative and postoperative periods at 24 hours).…”

Section: Introductionmentioning

confidence: 99%

Deep fascia iliaca block combined with sacral plexus block for hip fracture surgery: A retrospective series of cases

Almeida

¹

2023

Indian Journal of Anaesthesia

View full text Add to dashboard Cite

This case series describes a novel anaesthetic approach for hip fracture surgery using the deep fascia iliaca block combined with the sacral plexus block. This single-centre, retrospective study involved 15 patients aged 85 years or older and having significant cardiac disease. All the patients were managed with single-shot deep fascia iliaca block (22 or 25 ml of ropivacaine 0.5%) and sacral plexus block (12 or 15 ml of ropivacaine 0.5%, according to the patients’ weight) after the administration of 50 μg of fentanyl intravenously. Intraoperatively, the patients were also administered light-to-moderate sedation. All patients presented a successful sensory block and a high level of haemodynamic stability (nil vasopressor consumption). In hip fracture surgery, low volume deep fascia iliaca block may be combined with sacral plexus block as primary anaesthetic technque, without any neuraxial technique or sympathetic blockade.

show abstract

“…The use of CSA is well recognized to have a limited effect on hypotension. 13 It also allows us to study the hemodynamics in a prolonged period prior to surgery, minimizing the potential for other factors such as positioning, sedation and surgical stress to influence the measurements in a way a single shot spinal does not. The hemodynamics were monitored with LiDCOplus.…”

Section: Introductionmentioning

confidence: 99%

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Olsen

¹

,

Segerstad²,

Dalla³

et al. 2023

F1000Res

1

0

View full text Add to dashboard Cite

Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.

show abstract

“…The use of CSA is well recognized to have a limited effect on hypotension. 14 It also allows us to study the hemodynamics in a prolonged period prior to surgery, minimizing the potential for other factors such as positioning, sedation and surgical stress to influence the measurements in a way a single shot spinal does not. The hemodynamics were monitored with LiDCOplus.…”

Section: Introductionmentioning

confidence: 99%

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Olsen,

Hård af Segerstad,

Dalla

et al. 2023

F1000Res

0

View full text Add to dashboard Cite

Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.

show abstract

Low-dose spinal block for hip surgery: A systematic review

Cited by 5 publications

References 37 publications

Deep fascia iliaca block combined with sacral plexus block for hip fracture surgery: A retrospective series of cases

Deep fascia iliaca block combined with sacral plexus block for hip fracture surgery: A retrospective series of cases

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Contact Info

Product

Resources

About