title: Hemodynamic impact of isobaric levobupivacaine versus hyperbaric bupivacaine for subarachnoid anesthesia in patients aged 65 and older undergoing hip surgery.
abstract: BACKGROUND
  The altered hemodynamics, and therefore the arterial hypotension is the most prevalent adverse effect after subarachnoid anesthesia. The objective of the study was to determine the exact role of local anesthetic selection underlying spinal anesthesia-induced hypotension in the elderly patient. We conducted a descriptive, observational pilot study to assess the hemodynamic impact of subarachnoid anesthesia with isobaric levobupivacaine versus hyperbaric bupivacaine for hip fracture surgery.
  
  
  METHODS
  Hundred twenty ASA status I-IV patients aged 65 and older undergoing hip fracture surgery were enrolled. The primary objective of our study was to compare hemodynamic effects based on systolic blood pressure (SBP) and dyastolic blood pressure (DBP) values, heart rate (HR) and hemoglobin (Hb) and respiratory effects based on partial oxygen saturation (SpO2%) values. The secondary objective was to assess potential adverse events with the use of levobupivacaine versus bupivacaine. Assessments were performed preoperatively, at 30 minutes into surgery, at the end of anesthesia and at 48 hours and 6 months after surgery. Among intraoperative events, the incidence of hypotension was statistically significantly higher (p <0.05) in group BUPI (38.3%) compared to group LEVO (13.3%). There was a decrease (p <0.05) in systolic blood pressure (SBP) and diastolic blood pressure (DBP) at 30 minutes intraoperatively (19% in group BUPI versus 17% in group LEVO). SpO2% increased at 30 minutes after anesthesia onset (1% in group BUPI versus 1.5% in group LEVO). Heart rate (HR) decreased at 30 minutes after anesthesia onset (5% in group BUPI versus 9% in group L). Hemoglobin (Hb) decreased from time of operating room (OR) admission to the end of anesthesia (9.3% in group BUPI versus 12.5% in group LEVO). The incidence of red blood cell (RBC) transfusion was 13.3% in group BUPI versus 31.7% in group LEVO, this difference was statistically significant. Among postoperative events, the incidence of congestive heart failure (CHF) was significantly higher in group BUPI (8,3%). At 6 months after anesthesia, no differences were found.
  
  
  CONCLUSIONS
  Given the hemodynamic stability and lower incidence of intraoperative hypotension observed, levobupivacaine could be the agent of choice for subarachnoid anesthesia in elderly patients.
authors.affiliation: Department of Anesthesiology, Critical Care and Pain Management, Consorcio Hospital General Universitario (CHGUV), Valencia, Spain.
authors.forename: Rosa
authors.initials: R
authors.lastname: Herrera
authors.affiliation: Department of Surgery, Medical School, University of Valencia, Valencia, Spain.
authors.forename: Jose
authors.initials: J
authors.lastname: De Andrés
authors.affiliation: Medical School, University of Valencia, Valencia, Spain.
authors.forename: Luis
authors.initials: L
authors.lastname: Estañ
authors.affiliation: Medical School, University of Valencia, Valencia, Spain.
authors.forename: Francisco J Morales
authors.initials: FJ
authors.lastname: Olivas
authors.affiliation: Fundación Hospital General Universitario, Valencia, Spain.
authors.forename: Inocencia
authors.initials: I
authors.lastname: Martínez-Mir
authors.affiliation: Department of Anaesthesiology and Intensive Care Therapy, University Hospital Giessen-Marburg, Faculty of Medicine, Philipps University, Marburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Steinfeldt
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000772:Anesthesia, Local / Q000379:methods*; D000779:Anesthetics, Local / Q000009:adverse effects*; D001274:Atmospheric Pressure; D002045:Bupivacaine / Q000009:adverse effects / Q000031:analogs & derivatives*; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006620:Hip Fractures / Q000601:surgery*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D000077554:Levobupivacaine; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000379:methods*; D010865:Pilot Projects; D015656:Respiratory Mechanics / Q000187:drug effects; D013346:Subarachnoid Space
chemical_list: D000779:Anesthetics, Local; D000077554:Levobupivacaine; D002045:Bupivacaine
keywords: Bupivacaine; Elderly; Hip fracture; Levobupivacaine; Subarachnoid block