title: Spinal anesthesia using single injection small-dose bupivacaine versus continuous catheter injection techniques for surgical repair of hip fracture in elderly patients.
abstract: Aging and disease may make elderly patients particularly susceptible to hypotension during spinal anesthesia. We compared the hemodynamic effect of continuous spinal anesthesia (CSA) and small dose single injection spinal anesthesia (SA) regarding the incidence of hypotension. Seventy-four patients aged >75 yr undergoing surgical repair of hip fracture were randomized into 2 groups of 37 patients each. Group CSA received a continuous spinal anesthetic with a titration of 2.5 mg boluses every 15 min of isobaric bupivacaine, while group SA received a single injection spinal anesthetic with 7.5 mg of isobaric bupivacaine. The overall variations in noninvasive automated arterial blood pressure were not statistically significantly different in the 2 groups at baseline and after CSA or SA (not significant). In the SA group, 68% of patients experienced at least one episode of hypotension (decrease in systolic arterial blood pressure greater than 20% of baseline value) versus 31% of patients in the CSA group (P = 0.005). In the SA group, 51% of patients experienced at least one episode of severe hypotension (decrease in systolic arterial blood pressure more than 30% of baseline value) versus 8% of patients in the CSA group (P < 0.0001). In the CSA group, 4.5 +/- 2 mg of ephedrine was injected versus 11 +/- 2 mg in the SA group (P = 0.005). In the CSA group, 5 mg (2.5-10) of anesthetic solution was required versus 7.5 mg in the SA group (P < 0.0001). We conclude that, in elderly patients undergoing hip fracture repair, CSA provides fewer episodes of hypotension and severe hypotension compared with a single intrathecal injection of 7.5 mg bupivacaine.
authors.affiliation: Department of Anesthesiology and Intensive Care, University Hospital of Toulouse, University of Paul Sabatier, Toulouse, France. vincentminville@yahoo.fr
authors.forename: Vincent
authors.initials: V
authors.lastname: Minville
authors.forename: Olivier
authors.initials: O
authors.lastname: Fourcade
authors.forename: David
authors.initials: D
authors.lastname: Grousset
authors.forename: Clément
authors.initials: C
authors.lastname: Chassery
authors.forename: Luc
authors.initials: L
authors.lastname: Nguyen
authors.forename: Karim
authors.initials: K
authors.lastname: Asehnoune
authors.forename: Aline
authors.initials: A
authors.lastname: Colombani
authors.forename: Lounès
authors.initials: L
authors.lastname: Goulmamine
authors.forename: Kamran
authors.initials: K
authors.lastname: Samii
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000775:Anesthesia, Spinal / Q000379:methods*; D002045:Bupivacaine / Q000008:administration & dosage*; D002408:Catheters, Indwelling; D005260:Female; D006620:Hip Fractures / Q000188:drug therapy* / Q000601:surgery*; D006801:Humans; D008297:Male; D011446:Prospective Studies
chemical_list: D002045:Bupivacaine