Hip Fracture, Hypotension
Conditions
Keywords
hip fracture, elderly, continous spinal anesthesia, hypobaric bupivacaine, isobaric bupivacaine, hypotension
Brief summary
The study evaluates the potential beneficial effects on hemodynamics when hypobaric bupivacaine is used instead of isobaric bupivacaine in continuous spinal anesthesia for surgical repair of hip fracture in elderly patients. Half of the patients will receive hypobaric bupivacaine and the over half will reveive isobaric bupivacaine and hemodynamic data will be compared.
Detailed description
Anesthesia for surgical repair of hip fracture is still controversial. Large retrospective studies and systematic reviews failed to demonstrate the superiority of either general or regional anesthesia. However, continuous spinal anesthesia has been shown to preserve hemodynamics better than general and single shoot spinal anesthesia. However, hypotension still occurs with continuous spinal anesthesia. Unilateral spinal anesthesia may be achieved by hypobaric bupivacaine when patients are in the lateral position. Unilateral spinal anesthesia is more effective in preserving hemodynamics by limiting the spread of the sympathetic blockade to the operated side. Our goal is to show that the use of hypobaric rather than isobaric bupivacaine in continuous spinal anesthesia for surgical repair of hip fracture reduces incidence of hypotension.
Interventions
PROCEDUREcontinuous spinal anesthesia
Spinal puncture performed with a 19-gauge Tuohy needle at the L4-L5 or L3-L4 interspace using a midline approach. 3 cm of a 22-gauge catheter introduced through the needle, directed to the fractured side.
DRUGhypobaric bupivacaine
hypobaric bupivacaine was prepared diluting each 1 ml of 0.5% isobaric bupivacaine with 1 ml of sterile water.
0.5% isobaric bupivacaine
DRUGephedrine
Sponsors
Institut Kassab d'Orthopédie
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients aged more than 65 years and scheduled for a surgical repair of a hip fracture.
Exclusion criteria
* contraindication to spinal anesthesia or peripheral nerve blocks including hemostasis anomalies, local infection, allergic reaction to local anesthetics. * dementia. * consent refusal.
Design outcomes
Primary
| Measure | Time frame |
|---|---|
| The percentage of patients who experienced at least one episode of hypotension during surgery (fall of more than 20% of systolic blood pressure) among the 2 groups | 2 hours |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Total bupivacaine consumption | 2 hours | total dose of bupivacaine needed to perform the surgery (approximate duration of surgery : 2 hours) |
| The percentage of patients who experienced at least one episode of bradycardia (heart rate<50 bpm) among the 2 groups | 2 hours | — |
| vasopressor use | 2 hours | total ephedrine injected if hypotension occurred (approximate duration of surgery : 2 hours). |
| fluid infusion | 2 hours | total fluid infused intravenously at the end of surgery (approximate duration of surgery : 2 hours). |
Countries
Tunisia
Contacts
Primary ContactKarim Raies, A. Professor
Outcome results
None listed