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March 28, 2026BMC GeriatricsOpen Access

Impact of bupivacaine dose on haemodynamics in elderly hip surgery: a randomized controlled trial

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Key result

Spinal 5 mg bupivacaine cuts intraoperative hypotension ~65% vs 7.5 mg in elderly hip fracture patients.

  • P<0.001
  • n=68

Why the study?

Elderly patients with hip fractures are at high risk of hypotension during spinal anaesthesia, and lowering the intrathecal local anesthetic dose may help reduce haemodynamic instability.

Does 5 mg of 0.5% hyperbaric bupivacaine reduce the incidence of hypotension compared to 7.5 mg in elderly patients undergoing hip fracture surgery?

Population

Patients aged 65 years and older scheduled for hip fracture surgery

Comparison

5 mg vs 7.5 mg of 0.5% hyperbaric bupivacaine

Design

Prospective, randomized controlled study

Authors

MMMilas MafizerDüzce ÜniversitesiFAFatma Kavak AkelmaÇankaya UniversityBNBurak NalbantÇankaya University

Discussion

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Implication

Supports low-dose spinal anesthesia in elderly hip fracture patients; challenges conventional 7.5 mg dosing as standard.

Key Points

  • This research aims to evaluate the effects of different bupivacaine doses on haemodynamic stability in elderly patients undergoing hip surgery.
  • Prospective randomized controlled trial
  • Patients aged ≥ 65 scheduled for hip fracture surgery
  • Comparison of two low-dose spinal anesthesia protocols (5 mg vs. 7.5 mg bupivacaine)
  • Assessment of perioperative monitoring including perfusion index and hypotension incidence
  • Use of a pericapsular nerve group block for analgesia prior to spinal anesthesia
  • Significantly lower incidence of hypotension in Group B5 (26.4%) compared to Group B7.5 (76.4%), p < 0.001
  • Less ephedrine required in Group B5 (2.65 mg) than in Group B7.5 (15.29 mg), p < 0.001
  • Faster dermatomal regression and earlier Bromage scale recovery in Group B5
  • Shorter discharge time in Group B5

Study Design

Type

RCT (n=68)

Blinding

Double-blind (patient and outcome assessor/data recorder blinded)

Randomization

Computer-generated randomization sequence (1:1 ratio)

Multicenter

No

Structured PICO

Does 5 mg of 0.5% hyperbaric bupivacaine reduce the incidence of hypotension compared to 7.5 mg in elderly patients undergoing hip fracture surgery?

P
Population
76 patients aged ≥65 years scheduled for surgery for hip fracture, BMI 18-40 kg/m², ASA physical status I-III. Excluded: ASA IV or higher, LVEF <40%, cardiac arrhythmia, peripheral vascular disease, and pre-existing motor or sensory impairment.
I
Intervention
5 mg of 0.5% hyperbaric bupivacaine administered via spinal anaesthesia in the lateral decubitus position, preceded by a PENG (pericapsular nerve group) block with 20 mL of 0.25% bupivacaine.
C
Comparator
7.5 mg of 0.5% hyperbaric bupivacaine administered via spinal anaesthesia in the lateral decubitus position, preceded by a PENG block with 20 mL of 0.25% bupivacaine.
O
Outcome
Haemodynamic changes, specifically intraoperative arterial hypotension (defined as a ≥25% decrease in SBP from baseline or an absolute SBP <100 mmHg at any time during surgery).safety

Main Result

Absolute Event Rate: 26.4% vs 76.4%

p-value: p=<0.001

In elderly patients undergoing hip fracture surgery, a low-dose spinal anaesthesia protocol using 5 mg of hyperbaric bupivacaine significantly reduces the incidence of hypotension and shortens hospital stay compared to a conventional 7.5 mg dose.

Limitations

  • Spinal anaesthesia was performed using a landmark-based technique rather than ultrasound guidance
  • Invasive blood pressure monitoring was not used
  • Relatively small sample size
  • Frailty was not formally assessed with a standardized scale
  • No long-term follow-up beyond the immediate perioperative period

Cite This Study

Mafizer et al. (2026) conducted an RCT in Hip fracture (n=68). Hyperbaric bupivacaine (0.5%) vs. 7.5 mg hyperbaric bupivacaine (0.5%) was evaluated on Incidence of intraoperative hypotension (p=<0.001). Spinal anaesthesia with 5 mg hyperbaric bupivacaine significantly reduced the incidence of intraoperative hypotension compared to 7.5 mg (26.4% vs 76.4%) in elderly patients with hip fractures.

synapsesocial.com/papers/69c772818bbfbc51511e30a2https://doi.org/10.1186/s12877-026-07374-1
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Anaesthesia for 1131 patients undergoing proximal femoral fracture repair: a retrospective, observational study of effects on blood pressure, fluid administration and perioperative anaemia2011 · 66 citations
  2. 2Hypotension during hip fracture surgery and postoperative morbidity2020 · 34 citations
  3. 3Fascia iliaca block in the emergency department for hip fracture: a randomized, controlled, double-blind trial2019 · 35 citations
  4. 4The predictive ability of non‐invasive haemodynamic parameters for hypotension during caesarean section: a prospective observational study2015 · 70 citations
  5. 5The effect of time-to-surgery on outcome in elderly patients with proximal femoral fractures2008 · 184 citations