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. 2018 Apr;46(2):121-130.
doi: 10.5152/TJAR.2018.90699. Epub 2018 Apr 1.

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial

Pascal Meuret  1 , Lionel Bouvet  2 , Benoit Villet  1 , Mohamed Hafez  3 , Bernard Allaouchiche  2 , Emmanuel Boselli  2   4
Affiliations

Hypobaric Unilateral Spinal Anaesthesia versus General Anaesthesia in Elderly Patients Undergoing Hip Fracture Surgical Repair: A Prospective Randomised Open Trial

Pascal Meuret et al. Turk J Anaesthesiol Reanim. 2018 Apr.

Abstract

Objective: Intraoperative hypotension during hip fracture surgery is frequent in the elderly. No study has compared the haemodynamic effect of hypobaric unilateral spinal anaesthesia (HUSA) and standardised general anaesthesia (GA) in elderly patients undergoing hip fracture surgical repair.

Methods: We performed a prospective, randomised open study, including 40 patients aged over 75 years, comparing the haemodynamic effects of HUSA (5 mg isobaric bupivacaine with 5 μg sufentanil and 1 mL sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). An incidence of severe hypotension, defined by a decrease in systolic blood pressure of >40% from baseline, was the primary endpoint.

Results: The incidence of severe hypotension was lower in the HUSA group compared with that in the GA group (32% vs. 71%, respectively, p=0.03). The median [IQR] ephedrine consumption was lower (p=0.001) in the HUSA group (6 mg, 0-17 mg) compared with that in the GA group (36 mg, 21-57 mg). Intraoperative muscle relaxation and patients' and surgeons' satisfaction were similar between groups. No difference was observed in 5-day complications or 30-day mortality.

Conclusion: This study shows that HUSA provides better haemodynamic stability than GA, with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anaesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.

Keywords: Frail elderly; bupivacaine; fractures; hip; spinal anesthesia.

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Conflict of interest statement

Conflict of Interest: No conflict of interest was declared by the authors.

Figures

Figure 1
Figure 1
Flow chart
Figure 2
Figure 2
Evolution of systolic blood pressure with time between the groups (analysis of variance for repeated measures) Open circles (○) represent unilateral spinal anaesthesia and filled circles (●) represent general anaesthesia. Error bars denote 95% confidence interval
Figure 3
Figure 3
Evolution of heart rate with time between the groups (analysis of variance for repeated measures) Open circles (○) represent unilateral spinal anaesthesia and filled circles (●) represent general anaesthesia. Error bars denote 95% confidence interval
See this image and copyright information in PMC

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