Low-dose bupivacaine with sufentanil prevents hypotension after spinal anesthesia for hip repair in elderly patients.
BACKGROUND
Hip fracture is common in the geriatric population. Patients in this group are often at high risk for perioperative complications from concurrent diseases. Conventional spinal anesthesia can be associated with hypotension but has a better postoperative outcome compared to general anesthesia. We judged that a reduced dose of bupivacaine in combination with sufentanil could give reliable blocks with minimal hypotension.


METHODS
Fifty elderly patients were randomized into two groups. The study group received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and sufentanil 5 microg while the control group received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared.


RESULTS
All patients had adequate duration of reliable blocks. More control group patients than study group patients required ephedrine due to hypotension.


CONCLUSIONS
A reduced dose of hyperbaric bupivacaine (7.5 mg) in combination with sufentanil (5 microg) provides reliable spinal anesthesia for the repair of hip fracture in aged patients with few events of hypotension and little need for vasopressor support of blood pressure.
Olofsson
C
C
Department of Anesthesiology and Intensive Care, Karolinska Hospital, Stockholm, Sweden. nina.olofsson@ks.se
Nygårds
E-B
EB
Bjersten
A-B
AB
Hessling
A
A
D000368:Aged; D000775:Anesthesia, Spinal / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000779:Anesthetics, Local / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002045:Bupivacaine / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004809:Ephedrine / Q000008:administration & dosage / Q000627:therapeutic use; D005260:Female; D006439:Hemodynamics / Q000187:drug effects; D006615:Hip / Q000601:surgery*; D006620:Hip Fractures / Q000601:surgery; D006801:Humans; D007022:Hypotension / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D009407:Nerve Block; D019637:Orthopedic Procedures; D011183:Postoperative Complications / Q000503:physiopathology / Q000517:prevention & control*; D017409:Sufentanil / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D014662:Vasoconstrictor Agents / Q000008:administration & dosage / Q000627:therapeutic use
D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D014662:Vasoconstrictor Agents; D017409:Sufentanil; D004809:Ephedrine; D002045:Bupivacaine