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Review
. 2022 May 8;2(1):19.
doi: 10.1186/s44158-022-00047-6.

Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis

Antonio Messina  1   2 , Luigi La Via  3 , Angelo Milani  1 , Marzia Savi  1 , Lorenzo Calabrò  1 , Filippo Sanfilippo  4 , Katerina Negri  1 , Gianluca Castellani  1 , Gianmaria Cammarota  5 , Chiara Robba  6 , Emanuela Morenghi  1   2 , Marinella Astuto  4   7 , Maurizio Cecconi  1   2
Affiliations
Review

Spinal anesthesia and hypotensive events in hip fracture surgical repair in elderly patients: a meta-analysis

Antonio Messina et al. J Anesth Analg Crit Care. .

Abstract

Background: Spinal anesthesia (SA) is widely used for anesthetic management of patients undergoing hip surgery, and hypotension is the most common cardiovascular side effect of SA. This paper aims to assess the lowest effective dose of SA that reduces the occurrence of intraoperative hypotension in elderly patients scheduled for major lower limb orthopedic surgery.

Methods: We conducted a systematic review of randomized controlled trials (RCTs) performed in elderly patients scheduled for surgical hip repair and a meta-analysis with meta-regression on the occurrence of hypotensive episodes at different effective doses of anesthetics. We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials registered.

Results: Our search retrieved 2085 titles, and after screening, 6 were finally included in both the qualitative and quantitative analysis, including 344 patients [15% (10-28) males], with a median (25th to 75th interquartile) age of 82 (80-85). The risk of bias assessment reported "low risk" for 5 (83.3%) and "some concerns" for 1 (16.7%) of the included RCTs. The low dose of SA of [mean 6.5 mg (1.9)] anesthetic was associated with a lower incidence of hypotension [OR = 0.09 (95%CI 0.04-0.21); p = 0.04; I2 = 56.9%], as compared to the high-dose of anesthetic [mean 10.5 mg (2.4)].

Conclusions: In the included studies of this meta-analysis, a mean dose of 6.5 mg of SA was effective in producing intraoperative comfort and motor block and associated with a lower incidence of hypotension as compared to a mean dose of 10.5 mg.

Trial registration: CRD42020193627.

Keywords: Hip fracture; Hypotension; Spinal anesthesia.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow of the studies. *Excluded studies are reported in Supplemental Table 4 in the Online Supplemental Materials
Fig. 2
Fig. 2
Cochrane Collaboration’s Risk of Bias assessment and summary (RoB-2 version 2019) [27]. Green circles = low bias; yellow circles = some concerns
Fig. 3
Fig. 3
Forrest plot regarding the effect of low/high spinal anesthesia dose in the included trials included in the quantitative analysis. OR, odds ratio; CI, confidence interval
Fig. 4
Fig. 4
Publication bias funnel plot (with 95% confidence limits)
See this image and copyright information in PMC

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