Abstract
Neuraxial anaesthesia particularly spinal anaesthesia is the most popular form of anaesthesia for surgical repair of hip in the elderly because of its excellent operating conditions. But the associated high incidence of bradycardia and hypotension may be deleterious for them.
Aims: To compare standard dose of bupivacaine with fentanyl vs. low dose bupivacaine with fentanyl for surgical repair of hip in elderly females with regard to its hemodynamic stability and adequacy for the procedure.
Methods and Materials: After ethical committee approval and informed consent from patients a prospective observational study was performed on elderly females posted for elective or emergency surgical repair of hip fracture under spinal anaesthesia. This study was done among two comparable groups of ASA status I-IV and age 65 yrs and above. Low dose (Group A) received 1 ml of 0.5 % bupivacaine with25 µg fentanyl and Standard dose (Group B ) received 2 ml of 0.5% bupivacaine with 25 µg fentanyl.
Statistical software: MS Excel, SPSS version 22 (IBM SPSS Statistics, Somers NY, USA) was used to analyze data.
Results: Low dose spinal provides adequate duration of analgesia. Significant difference in mean blood pressure (BP) between 2 groups (P=0.001).Dose of vasopressors required to maintain BPin low dose ( vs. (13.6 ± 7.4 mg)in standard dose group. Onset of sensory block delayed in low dose group.
Conclusions: This study shows that low dose spinal anaesthesia provides adequate anaesthesia for surgical repair of hip fracture in elderly females with excellent hemodynamic stability.
References
- Singer BR, McLauchlan GJ, Robinson CM, Christie J. Epidemiology of fractures in 15,000 adults: the influence of age and gender. J Bone Joint Surg Br 1998;80:243-48. [Pubmed]
- Bogra J, Arora N, Srivastava P. Synergistic effect of intrathecal fentanyl and bupivacaine in spinal anesthesia for cesarean section. BMC Anesthesiology 2005;5:5. [Pubmed]
- Venkata HG, Pasupuleti S, Pabba UG, Porika S, Talari G. A randomized controlled prospective study comparing a low dose bupivacaine and fentanyl mixture to a conventionaldose of hyperbaric bupivacaine for cesarean section. Saudi J of Anaesth. 2015;9:122-7.[Pubmed]
- Todd CJ, Freeman CJ, Camilleri-Ferrante C, Palmer CR, Hyder A, Laxton CE, et al. Differences in mortality after fracture of hip: the east Anglian audit. BMJ 1995;310:904–8.[Pubmed]
- Rodgers A, Walker N, Schug S, McKee A, Kehlet H, van Zundert A, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ 2000;321:1493.[Pubmed]
- Charlson ME, MacKenzie CR, Gold JP, Ales KL, TopinsM et al. The preoperative and intraoperative hemodynamic predictors of postoperative myocardial infarction or ischemia in patients undergoing non cardiac surgery.Ann Surg 1989;210:637-48. [Pubmed]
- Park HJ, Kang H, Lee J-W, Baek SM, Seo JS. Comparison of hemodynamic changes between old and very old patients under-going cemented bipolar hemiarthroplasty under spinal anesthesia. Korean Journal of Anesthesiology 2015;68(1):37-42. [Pubmed]
- Wood RJ, White SM. Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective observational study of effects on blood pressure, fluid administration and perioperative anaemia. Anaesthesia 2011;66:1017-22. [Pubmed]
- Mohammad Qamarul Hoda, Sabir Saeed, GauharAfshan, Salman Sabir. Hemodynamic effects of intrathecal bupivacaine for surgical repair of hip fracture. JPMA 2017;57:245. [Pubmed]
- Gupta S, Sampley S, Kathuria S, Katyal S. Intrathecalsufentanil or fentanyl as adjuvants to low dose bupivacaine in endoscopic urological procedures. J Anaesthesiol Clin Pharmacol2013;29:509-15. [Pubmed]
- Ben-David B, Frankel R, Arzumonov T, Marchevsky Y, Volpin G. Minidose bupivacaine-fentanyl spinal anesthesia for surgical repair of hip fracture in the aged. Anaesthesiology2000;92:6-10.[Pubmed]
- Kumar A, Kumar R, Verma VK, Prasad C, Kumar R, Kant S, et al. A randomized controlled study between fentanyl and Butorphanol with low dose intrathecal bupivacaine to facilitate early postoperative ambulation in urological procedures. Anesthesia, Essays and Researches 2016;10:508-11. [Pubmed]
- Akcaboy ZN, Akcaboy EY, Mutlu NM, Serger N, Aksu C, Gogus N. Spinal anesthesia with low-dose bupivacaine-fentanyl combination: a good alternative for day case transurethral resection of prostrate surgery in geriatric patients. Rev Bras Anestesiol 2012;.62:753-61. [Pubmed]
- Girgin NK1, Gurbet A, Turker G, Bulut T, Demir S, Kilic N, et al. The combination of low-dose levobupivacaine and fentanyl for spinal anaesthesia in ambulatory inguinal herniorrhaphy. J Int Med Res.2008;36:1287-92. [Pubmed]
- Veering BT, Burm AGL, Spierdijk J. Spinal anesthesia with hyperbaric bupivacaine: effects of age on neural blockade and pharmacokinetics. Br J Anaesth1988;60:187–94.[Pubmed]
- Kararmaz A, S. Kaya S. Turhanoglu S. Ozyilmaz MA. Low-dose bupivacaine-fentanyl spinal anaesthesia for transur-ethral prostatectomy. Anaesthesia 2003;58:526-30. [Pubmed]
- Atallah MM, Shorrab AA, Abdel Mageed YM, Demian AD. Low-dose bupivacaine spinal anaesthesia for percutaneous nephrolithotomy: The suitability and impact of adding intrathecal fentanyl. Acta AnaesthesiolScand 2006;50:798–803. [Pubmed]
- Nayagam HA, Singh NR, Singh HS. A prospective randomised double blind study of intrathecal fentanyl and dexmedetomidine added to low dose bupivacaine for spinal anesthesia for lower abdominal surgeries. Indian J Anaesth. 2014;58:430-35.[Pubmed]
- Labbene I, Lamine K, Gharsallah H, Jebali A, Adhoum A, Ghozzi S, et al. Spinal anesthesia for endoscopic urological surgery -- low dose vs. varying doses of hyperbaric bupivacaine. Middle East J Anaesthesiol. 2007;19:369–84 [Pubmed]
Corresponding Author
Dr Biby Mary Kuriakose
Assistant Professor Anaesthesiolgy, Government T D Medical College Alappuzha, India
Mob: 9495234951 Email: This email address is being protected from spambots. You need JavaScript enabled to view it.
DOI: https://dx.doi.org/10.18535/jmscr/v6i5.125
