A mixture of opioids and subtherapeutic doses of local anaesthetic in spinal anaesthesia for lower limb surgery in the elderly

S. Bâldea¹, L. Szegedi²
1. Secţia A.T.I., Spitalul Judeţean Buzău
2. Clinica A.T.I., Spitalul Clinic Judeţean Oradea

Abstract

Background. The results of a previous study demonstrated that 1.5 ml of 0.5% bupivacaine (7.5 mg) represents the appropriate volume for spinal anaesthesia in hip trauma surgery of elderly patients.

The aim of the study was to evaluate if the local anaesthetic (isobaric 0.5%, bupivacaine) with opioids (fentanyl, pethidine) within the limit of 1.5 ml volume, offers a better analgesia, modifies the haemodynamic profile, influences postoperative pain, the incidence of complications and particularly the incidence of postoperative delirium in elderly patients.

Materials and methods. Spinal anaesthesia was performed in 60 patients, aged 65 to 93 for lower limb traumatic surgery, randomized in 3 groups of 20 patients: group 1, with 1.5 ml isobaric 0.5 % bupivacaine (7.5 mg); group 2, with 1 ml isbaric 0.5%, bupivacaine (5 mg) + 0.5 ml fentanyl (25 g); group 3, 1 ml isobaric 0.5% bupivacaine (5 mg) + 0,5 ml pethidine 5% (25 mg).
When the systolic blood pressure (SBP) dropped more than 25% of the preanaesthetic value, 5 mg of ephedrine was administered repeatedly for as long as it was necessary to maintain the SBP above 75% of the initial value. The following parameters were monitored: the onset, quality, duration and extension of the sensitive block, the intensity of the haemodynamic changes, the presence of the specific complications of subarachnoidian administered opioids, the duration of postoperative analgesia and the incidence of postoperative delirium.

Results. A sensitive block of very good quality was noted in all groups. The best haemodynamic stability was noted in the second and third group.
Postoperative analgesia was significantly prolonged in the third group compared with the second and first groups. No case of postoperative delirium was noted.

Conclusions. The association of an opioid (fentanyl or pethidine) with a local anaesthetic (bupi-vacaine) for spinal anaesthesia in lower limb trauma surgery of elderly patients, offers a sensitive block of very good quality, stable haemodynamic parameters, a prolonged postoperative analgesia significantly longer with pethidine and the absence of postoperative delirium.

Key words: spinal anaesthesia, bupivacaine, fentanyl, pethidine, mixture, lower limb trauma surgery, elderly

STUDII CLINICE
Amestec de opioizi şi anestezic local în doze subterapeutice pentru rahianestezie la vârstnici, în intervenţiile ortopedice pe membrul inferior

Jurnalul Român de Anestezie Terapie intensivă 2005 Vol.12 Nr.2, 93-98