title: A comparative study-efficacy and safety of combined spinal epidural anesthesia versus spinal anesthesia in high-risk geriatric patients for surgeries around the hip joint.
abstract: BACKGROUND
  Combined spinal epidural anesthesia (CSEA) has a significant advantage by enabling the use of low dose intrathecal local anesthetic, with knowledge that the epidural catheter may be used to extend the block as necessary. CSEA is useful in high-risk geriatric patients by providing greater hemodynamic stability.
  
  
  OBJECTIVE
  This study is designed to compare the clinical effects of CSEA versus spinal anesthesia in high-risk geriatric patients undergoing surgeries around the hip joint.
  
  
  METHODS
  Sixty patients aged >65 years, American Society of Anaesthesiology III and IV were randomly allocated into two equal groups. Group A (n = 30) received CSEA with 1 ml (5 mg) of 0.5% hyperbaric bupivacaine with 25 μg fentanyl through spinal route, and the expected incompleteness of spinal block was managed with small incremental dose of 0.5% isobaric bupivacaine through epidural catheter, 1-1.5 ml for every unblocked segment to achieve T10 sensory level. Group B (n = 30) received spinal anesthesia with 2.5 ml (12.5 mg) of 0.5% hyperbaric bupivacaine and 25 μg fentanyl.
  
  
  RESULTS
  Both the groups showed rapid onset, excellent analgesia and good quality motor block. Group A showed a significantly less incidence of hypotension (P < 0.01) along with the provision of prolonging analgesia as compared to Group B.
  
  
  CONCLUSIONS
  CSEA is a safe, effective, reliable technique with better hemodynamic stability along with the provision of prolonging analgesia compared to spinal anesthesia for high-risk geriatric patients undergoing surgeries around the hip joint.
authors.affiliation: Department of Anaesthesiology, Katuri Medical College, Chinakondrupadu, Guntur, Andhra Pradesh, India.
authors.forename: Vengamamba
authors.initials: V
authors.lastname: Tummala
authors.affiliation: Department of Anaesthesiology, Katuri Medical College, Chinakondrupadu, Guntur, Andhra Pradesh, India.
authors.forename: Lella Nageswara
authors.initials: LN
authors.lastname: Rao
authors.affiliation: Department of Anaesthesiology, Katuri Medical College, Chinakondrupadu, Guntur, Andhra Pradesh, India.
authors.forename: Manoj Kumar
authors.initials: MK
authors.lastname: Vallury
authors.affiliation: Department of Anaesthesiology, Katuri Medical College, Chinakondrupadu, Guntur, Andhra Pradesh, India.
authors.forename: Anitha
authors.initials: A
authors.lastname: Sanapala
keywords: Combined spinal epidural anesthesia; high-risk geriatric patients; spinal anesthesia; surgeries around the hip joint