Comparison between hypobaric unilateral spinal anaesthesia and conventional spinal anesthesia in elderly patients for hip trauma

Objectives: To compare the effect of induction position (sitting versus lateral) for spinal anaesthesia in the elderly patient on hemodynamic, sensory block and motor block characteristics and patient satisfaction.Material and methods: Randomized controlled trial of patients undergoing spinal anaesthesia for lower abdominal, pelvic, lower limb and urological surgeries aged more than 60 years. Hyperbaric Bupivacain (0.05%) was injected into the spinal space while the patients were either in sitting or lateral position. Effects on hemodynamic parameters, sensory block and motor block characteristics and patient satisfaction were analysed.Results: Induction position for spinal anaesthesia does not affect the hemodynamic parameters and incidence of adverse effects when adequate preloading is done. There was no statistically significant difference in the sensory level and motor level achieved. However lateral position appears to be more comfortable for elderly patients (P= 0.03).Conclusions: Induction position for administration of spinal anaesthesia has no effect on hemodynamic parameters or block characteristics except that patients feel more comfortable in lateral position.Keywords: Spinal anesthesia, Induction position, Hyperbaric bupivacaine.

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Faculty Opinions recommendation of Sedation depth during spinal anesthesia and survival in elderly patients undergoing hip fracture repair.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718369638.793494666 ◽

2014 ◽

Author(s):

Berrin Gunaydin ◽

Bülent Serhan Yurtlu

Keyword(s):

Hip Fracture ◽

Elderly Patients ◽

Spinal Anesthesia ◽

Fracture Repair

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A Comparison of Oral Gabapentin and Oral Pregabalin as Preemptive Analgesia for Orthopedic Surgery Under Spinal Anaesthesia

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0901.15 ◽

2021 ◽

Vol 9 (1) ◽

pp. 74-78

Author(s):

Neena Jain ◽

Rahul Bankapur ◽

Preeti Lamba ◽

saurav Singh

Keyword(s):

Side Effects ◽

Postoperative Pain ◽

Spinal Anesthesia ◽

Spinal Anaesthesia ◽

Orthopedic Surgery ◽

Lower Limb ◽

Analgesic Efficacy ◽

Double Blind Study ◽

Group A ◽

Group B

Background and Aims: Gabapentin and pregabalin, by decreasing noxious stimulus induced excitatory neurotransmitter release at central nervous system, may attenuate central sensitization and eventually decrease development of postoperative pain. We evaluated preemptive analgesic efficacy of single dose of oral gabapentin 600 mg and pregabalin 75mg for postoperative pain in patients undergoing lower limb orthopedic surgery under spinal anesthesia. Material and methods: A prospective, randomized, double blind study was conducted on 70 patients aged between 18 to 60 years with ASA grade 1 and 2 posted for lower limb surgeries under spinal anaesthesia. Patients were allocated into Group A and Group B receiving oral gabapentin(600mg) and oral pregabalin (75mg) respectively 1.5 hours before surgery. Primary objective was assessing duration and quality of analgesia by Visual Analogue Scale (VAS) score at 2,4,6,8,10,12,16,20 and 24 hours.Secondary objective was to assess total dose of rescue analgesic in first 24 hours, perioperative hemodynamic change and various side effects. Statistical Analysis used: Categorical data was compared using Chi- square test. Quantitative parametric data was analysed using unpaired student t-test. P value < 0.05 was considered statistically significant. Results: Mean duration of analgesia in Group A (10.53 ± 2.686 hours) was longer than Group B (7.943±3.199hr) (P = 0.0006).Mean number of analgesic dosesrequired in first 24 hourswere less in Group A (1.429 ± 0.5021) ascompared to Group B (1.771±0.6897) (P = 0.0202).All patients remained hemodynamically stable with no significant side effects noted in either group. Conclusion: We conclude that preemptive analgesic efficacy of oral gabapentin 600mg is better in comparison to oral pregabalin 75 mg for patients posted for lower limb orthopedic surgeries under spinal anesthesia.

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Levobupivacaine in spinal anesthesia for primary knee and hip arthroplasty

N.N. Priorov Journal of Traumatology and Orthopedics ◽

10.17816/vto202027131-35 ◽

2020 ◽

Vol 27 (1) ◽

pp. 31-35

Author(s):

K. Yu. Ukolov ◽

V. L. Ayzenberg ◽

M. V. Kapirina ◽

M. E. Mikitina

Keyword(s):

Elderly Patients ◽

Spinal Anesthesia ◽

Knee Arthroplasty ◽

Hip Arthroplasty ◽

Postoperative Nausea And Vomiting ◽

Anaesthetic Agents ◽

Group I ◽

Primary Knee Arthroplasty ◽

Group Ii ◽

Knee And Hip Arthroplasty

Introduction. Spinal anesthesia is widely used in major orthopedic. Primary hip and knee arthroplasty are major surgical procedures associated with significant potential morbidity in elderly patients. This increases requirement to surgical and anesthetic procedures. Some studies provide evidence that levobupivacaine when used as an alternative to bupivacaine in spinal anesthesia is less cardiotoxic and neurotoxic. Aim: To compare the efficacy and safety of these two spinal anaesthetic agents in elderly patients undergoing primary hip or knee replacement. Patients and methods. The study included 90 patients performed arthroplasty with spinal anesthesia. I group patients received spinal anesthesia bupivacaine 0,5%, II group patients received intrathecal levobupicavaine 0.5%. Group I (n=60), 22 (37%) underwent primary hip arthroplasty, and 38 (63%) patients that underwent primary knee arthroplasty with mean age (65,4 + 6,5). Group II (n=30), 18 (60%) patients that underwent primary total hip arthroplasty and 12 (40%) patients that underwent primary knee arthroplasty with mean age (65,5 + 8,1). Anesthesia algorithm did not differ for both groups. Results. Vital parameters and adverse effects in relation to spinal anesthesia were observed. Decrease of heart rate was more significant in group II. Blood pressure parameters were comparable to both groups though, 10% of Group I patients received infusion of norepinephrine for treatment of hypotension. The two groups were comparable with glucose and lactate variations as well as the duration of analgesia and postoperative nausea and vomiting. No postoperative delirium was noted in both groups. Conclusion. Spinal anesthesia with levobupivacaine is more safe for elderly patients undergoing knee and hip arthroplasty.

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