Geriatric Patient, Hip Surgery, Spinal Anesthesia
Conditions
Keywords
Geriatric patient, Hemodynamic changes, Hypobaric bupivacaine, hyperbaric bupivacaine
Brief summary
The frequency of hypotension is increased in geriatric patients due to physiological changes compared to the normal population. In this study, our aim is to compare the hemodynamic changes in geriatric patients undergoing hip surgery under spinal anesthesia with hypobaric and hyperbaric bupivacaine.
Detailed description
Patients will be randomly assigned to one of two groups: HypoB (% 0.5 bupivacaine 3cc+ 2cc distilled water) or HyperB (% 0.5 bupivacaine 3cc+ 2cc %10 dextrose). For pre-positioning analgesia, an intravenous dose of fentanyl at 0.5 mcg/kg will be administered. Patients will then be positioned in the appropriate lateral decubitus position based on whether hypobaric or hyperbaric bupivacaine is used. Spinal anesthesia will be performed using 3 cc local anesthetic solution, followed by 15 minutes of lateralization. During the surgery, hemodynamic parameters, sensory block levels at the 5th, 10th, 15th, and 20th minutes at lateral and supine position, and motor block levels with bromage scale at the 15th and 20th minutes at supine position will be recorded. The spread of the block to the T8 dermatome level was considered an indicator of a successful block. Hemodynamic parameters (blood pressure, heart rate, peripheral oxygen saturation) will be recorded at 0, 5, 10, 15, 20, 30, 40, 50, 60, 90, and 120 minutes intraoperatively. Patients will receive crystalloid infusion at a rate of 5-7 ml/kg per hour throughout the procedure. The volume of intraoperative bleeding, the amount of blood products administered, and the doses of ephedrine, atropine, and noradrenaline used will also be documented. If the heart rate falls below 45 beats per minute, 0.5 mg of intravenous atropine will be administered. A decrease in blood pressure of 20% or more from baseline will be defined as hypotension. In such cases, ephedrine will be administered. If hypotension persists despite a total dose of 20 mg ephedrine, a noradrenaline infusion will be initiated.
Interventions
PROCEDUREspinal anesthesia
spinal anesthesia with hypobaric and hyperbaric bupivacaine
Sponsors
Eskisehir Osmangazi University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Intervention will be performed in geriatric patients of hemodynamic changes (hypotension, bradycardia) associated with spinal anesthesia
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients over 65 years of age * Patients taken to surgery in a supine position due to femur fractures * Patients classified as ASA (American Society of Anesthesiologists) class I-III
Exclusion criteria
* History of allergy to the drug * Patients with coagulopathy * Patients refusing to participate in the study * Severe valve stenosis * Infection at the injection site * Inadequate spinal anesthesia level during surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hemodynamic effects of hypobaric and hyperbaric bupivacaine with spinal anesthesia | 2 hour | blood pressure monitoring |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Evaluation of sensorial block with hypobaric and hyperbaric bupivacaine in spinal anesthesia | 2 hour | sensorial block evaluate with pinprick test; sensorial block level; present/absent |
| Evaluation of motor block with hypobaric and hyperbaric bupivacaine in spinal anesthesia | 2 hour | motor block evaluate with bromage scale ;Grade 0: Full movement of hips, knees, and ankles (no block). Grade 1: Unable to lift the leg but can move knees and ankles (partial block). Grade 2: Unable to bend the knee but can move ankles (near-complete block). Grade 3: No movement in hips, knees, or ankles (complete block). |
Countries
Turkey (Türkiye)
Outcome results
None listed