Spinal Anesthesia in Elderly Patients
Conditions
Keywords
Fractionated spinal anesthesia, hyperbaric bupivacaine, isobaric bupivacaine, hip fructure, elderly patients
Brief summary
This prospective randomized controlled study will be conducted to compare the effect of fractionated SA using isobaric and hyperbaric bupivacaine with fractionated SA using hyperbaric bupivacaine and the conventional SA on hemodynamic instability in orthogeriatric patients undergoing hip fracture surgeries.
Detailed description
Hip fractures are one of the most common reasons for elderly patients to present to the emergency department and require urgent surgery. Despite the debate regarding the preferred type of anesthesia in the elderly population, spinal anesthesia has shown the advantage of the simplicity of the technique, the better analgesic profile, the lower incidence of thromboembolic events and lower hospital stay. Hemodynamic stability should be considered as a primary intraoperative target. In pursuit of optimizing spinal anesthesia, this study proposed that fractionated SA by sequential administration of low doses of isobaric and hyperbaric bupivacaine can minimize hemodynamic instability while leveraging the advantages of both solutions when compared with fractionated SA using hyperbaric bupivacaine or the conventional SA technique.
Interventions
PROCEDUREFractionated SA with isobaric and hyperbaric bupivacaine
patients will receive fractionated SA in two doses first dose of hyperbaric bupivacaine with fentanyl followed after 90 seconds by the second dose of isobaric bupivacaine.
PROCEDUREFractionated SA with hyperbaric bupivacaine
patients will receive fractionated SA in two doses of hyperbaric bupivacaine and fentanyl, two thirds of the dose will be given firstly followed by the last third after 90 seconds.
PROCEDUREConventional SA group
patients will receive the conventional SA bolus dose of hyperbaric bupivacaine and fentanyl.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
65 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Elderly patients of both gender aged 65 years or more with American Society of Anesthesiologists (ASA) Physical Status I-III, who were scheduled for hip fracture surgeries under Spinal anesthesia
Exclusion criteria
* Patients declined to participate in the trial. * Patients on anticoagulation therapy. * Patients planned for general anesthesia. * Patients with atrial fibrillation. * Allergies or hypersensitivity to local anesthetic drugs. * Spinal cord deformities. * Infection that contraindicate SA. * Preoperative motor and sensory deficits
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of intraoperative hypotension | MAP will be measured intraoperatively before spinal anesthesia (SA), immediately after administering SA and subsequently at regular intervals 5, 10, 20, 30, 60, 75, 90 minutes, and then every 30 minutes till the end of surgery. | Intraoperative hypotension is defined as the drop of systolic blood pressure (SBP) by 25% of the basal reading or the drop of MAP below 65 mmHg. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Incidence of bradycardia. | HR will be measured intraoperatively before spinal anesthesia (SA), immediately after administering SA and subsequently at regular intervals 5, 10, 20, 30, 60, 75, 90 minutes, and then every 30 minutes till the end of surgery. | Bradycardia is defined as sustained HR less than 60 beat/ minute |
| Vasopressor requirements. | intraoperatively after spinal anesthesia till the end of surgical intervention | total dose of vasopressors required intraoperatively |
| Postoperative pain score | immediately post operatively then every 30 minutes up to 2 hour | Visual analogue scale (VAS) is typically a 10-cm horizontal line labeled: * 0 = No pain * 10 = Worst imaginable pain A patient marks a point along the line to indicate their level of pain. The score is then measured in centimeters or millimeters to quantify pain intensity. |
| Time to first rescue analgesia | post operative .. time interval from the end of surgery until need of rescue analgesia | time interval from the end of surgery until need of rescue analgesia |
Countries
Egypt
Outcome results
None listed