[Turk J Anaesthesiol Reanim]
Turk J Anaesthesiol Reanim. Baskıdaki Makaleler: TARD-90699

Hypobaric unilateral spinal anesthesia versus general anesthesia in elderly patients undergoing hip fracture surgical repair: A prospective randomized open trial

Pascal Meuret1, Lionel Bouvet2, Benoit Villet1, Mohamed Hafez3, Bernard Allaouchiche2, Emmanuel Boselli4
1Hospices Civils de Lyon, Édouard Herriot Hospital, Department of Anesthesiology, Lyon, France
2University of Lyon, University Claude Bernard Lyon I, APCSe Vetagro Sup UPSP 2016.A101, Marcy-l'Étoile, France
3Hospices Civils de Lyon, Édouard Herriot hospital, Department of Orthopedic Surgery, Lyon, France
4Pierre Oudot Hospital Center, Department of Anesthesiology, Bourgoin-Jallieu, France

Objective: Intraoperative hypotension during hip fracture surgery in elderly is frequent. No study has compared the hemodynamic effect of hypobaric unilateral spinal anesthesia (HUSA) and standardized general anesthesia (GA) in elderly patients undergoing surgical repair of hip fracture.
Methods: We performed a prospective, randomized open study including 40 patients aged over 75 years comparing the hemodynamic effects of HUSA (isobaric bupivacaine 5 mg added with sufentanil 5 μg and 1 mL of sterile water) and GA (induction with etomidate/remifentanil and maintenance with desflurane/remifentanil). The primary endpoint was the incidence severe hypotension, defined by a decrease in systolic blood pressure by >40% from baseline.
Results: The incidence of severe hypotension was lower in the HUSA group compared to 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]) compared to the GA group (36 mg [21-57]). Intraoperative muscle relaxation, patients’ and surgeons’ satisfaction were similar between groups. No difference was observed in 5-day complications of 30-day mortality.
Conclusion: This study shows that HUSA provides better hemodynamic stability than GA with lower consumption of ephedrine and similar operating conditions. This new approach of spinal anesthesia seems to be safe and effective in elderly patients undergoing hip fracture surgery.

Keywords: Elderly, Hypobaric bupivacaine; Anesthesia, Unilateral spinal; Anesthesia, General; Fracture fixation, Internal

Sorumlu Yazar: Emmanuel Boselli, France

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