Spinal Anesthesia Using Single Injection Small-Dose Bupivacaine Versus Continuous Catheter Injection Techniques for Surgical Repair of Hip Fracture in Elderly Patients

Abstract

Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia. We compared the hemodynamic effect of continuous spinal anesthesia (CSA) and small dose single injection spinal anesthesia (SA) regarding the incidence of hypotension. Seventy-four patients aged >75 yr undergoing surgical repair of hip fracture were randomized into 2 groups of 37 patients each. Group CSA received a continuous spinal anesthetic with a titration of 2.5 mg boluses every 15 min of isobaric bupivacaine, while group SA received a single injection spinal anesthetic with 7.5 mg of isobaric bupivacaine. The overall variations in noninvasive automated arterial blood pressure were not statistically significantly different in the 2 groups at baseline and after CSA or SA (not significant). In the SA group, 68% of patients experienced at least one episode of hypotension (decrease in systolic arterial blood pressure greater than 20% of baseline value) versus 31% of patients in the CSA group (P = 0.005). In the SA group, 51% of patients experienced at least one episode of severe hypotension (decrease in systolic arterial blood pressure more than 30% of baseline value) versus 8% of patients in the CSA group (P < 0.0001). In the CSA group, 4.5 +/- 2 mg of ephedrine was injected versus 11 +/- 2 mg in the SA group (P = 0.005). In the CSA group, 5 mg (2.5-10) of anesthetic solution was required versus 7.5 mg in the SA group (P < 0.0001). We conclude that, in elderly patients undergoing hip fracture repair, CSA provides fewer episodes of hypotension and severe hypotension compared with a single intrathecal injection of 7.5 mg bupivacaine.

Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter?

“…Surveying the literature, both magnitude and frequency of hypotensive episodes are statistically significantly increased in patients with regional anaesthesia (evidence level II-III) [2,41,44,45,49,61] as well as the use of vasopressors (42.6% regional versus 14.3% general, P=0.001, evidence level II) [41]. Minville et al [63] showed less hypotension during continuous spinal anaesthesia and Juelsgaard et al [57], found evidence that hypotension is lowest only in patients receiving incremental doses of local anaesthetics, but observed no difference in the incidence of hypotension between anaesthetic techniques following single doses (evidence level II-III) [57,63]. Others reported no differences regarding hypotension comparing general and regional anaesthesia (evidence level II-III) [7, 25, 27, 29-31, 57, 65].…”

Effects of Spinal Anaesthesia on Left Ventricular Function: An Observational Study using Two-Dimensional Strain Echocardiography

“…Bulgular: Sol ventrikül ejeksiyon fraksiyonu SA ile değişmez iken, global boylamsal reconnoitering'de bir artış gözlendi (Δ−0,2±0,3% s We thought that this echocardiographic tool could bring a new perspective on the still controversial 'cardiac effect theory' of spinal anaesthesia (SA) (2)(3)(4)(5). Arterial hypotension is frequently observed during SA, especially in the elderly (6). This side effect, mainly due to preload and afterload decrease secondary to the sympathetic block, could cause a cardiac component per se (7).…”

“…Hypotension is frequently observed after SA, especially in the elderly (6). This side effect is an independent risk factor of mortality because of regional hypoperfusion (8).…”

Propofol to facilitate spinal anesthesia in the lateral position in patients with femoral neck fracture

“…[3][4][5][6] Cependant, l'anesthésie locorégionale, réalisée sous forme de rachianesthésie, présente certains avantages sur l'anesthésie générale. 7 Des données issues de la littérature montrent qu'une diminution de la dose d'anesthésique local injectée en intrathécal en injection unique 8-10 ou continue 11,12 permet un retentissement hémodynamique moindre.…”