Haemodynamic improvement in spinal anaesthesia for elderly patients undergoing hip surgery, by decreasing the local anaesthetic concentration of a constant volume

C. Rusan¹, I. Acalovschi², Adela Onuţu¹
1) Clinica de Ortopedie şi Traumatologie Cluj. 2) Clinica de Anestezie şi Terapie Intensivă Cluj, Centrul de Excelenţă ATI Cluj

Abstract

Spinal anaesthesia is acompanied by hypotension, wich is tolerated with dificulty by the elderly patients.The severity of intraanaesthesic hypotension is directly influenced by the extension and the intensity of vegetative block.
The aim of the study was to determine if the progressive dilution of a constant volume of a local anaesthetic and opioid mixture (bupivacaine + pethidine) may significantly improve the intra-anaesthesic haemodynamics maintaining an adequate analgesia in elderly patients undergoing surgery for hip fractures. Material and method. The study included 80 elderly patients (over 70 years) undergoing surgery for hip fractures in spinal anaesthesia. The basic solution for anaesthesia contained 1.25 ml bupivacaine 0,5%, (6.25 mg) + 0.25 ml pethidine 5% (12.5 mg), and was diluted progressively in 3 similar steps, so the final dilution contained a half dose of the initial substances. In this way, there were 4 groups of patients anaesthetised with decreasing doses, but with the same isobaric volume (1.5 ml). We presumed an intra-anaesthetic haemodynamic standard of 90% from the preanaesthetic values. To maintain this haemodynamic standard, the patients received 5 mg ephedrine/dose as often as necessary. The ephedrine necessity in every group was noted. The quality of analgesia and the intraanaesthesic haemodynamic changes were recorded.
Results. The maximal analgesia score and haemodynamic score were obtained from the patients in group 2 who received a solution of 1.5 ml containing 5.2 mg of bupivacaine + 10,4 mg pethidine. The need for ephedrine was only 5 mg in three patients. The same score was obtained in the patients from group 1, but the maintenance of a stable blood pressure imposed administration of 115 mg ephedrine. The patients from group 3 were haemodynamically stable with no need for ephedrine, but four of them complained of pain at the end of surgery. In the patients from group 4 the analgesia was inadequate.
Key words: spinal anaesthesia, constant volume, progressive dilution, elderly, hip fractures

Ameliorarea hemodinamicii din anestezia subarahnoidiană pentru chirurgia traumatismelor şoldului la vârstnici, prin reducerea concentraţiei unui volum constant de anestezic local

Jurnalul Român de Anestezie Terapie intensivă 2006 Vol.13 Nr.1, 10-16