A low mean dose of 6.5 mg of spinal anesthesia significantly reduced intraoperative hypotension compared to a high mean dose of 10.5 mg (OR 0.09) in elderly patients undergoing hip fracture repair.
Meta-Analysis (n=344)
Does a low dose of spinal anesthesia reduce intraoperative hypotension in elderly patients undergoing hip fracture surgical repair compared to a high dose?
In elderly patients undergoing hip fracture repair, a lower dose of spinal anesthesia (mean 6.5 mg) significantly reduces the risk of intraoperative hypotension compared to a higher dose (mean 10.5 mg).
Odds Ratio: 0.09 (95% CI 0.04–0.21)
p-value: p=0.04
Abstract Background Spinal anesthesia (SA) is widely used for anesthetic management of patients undergoing hip surgery, and hypotension is the most common cardiovascular side effect of SA. This paper aims to assess the lowest effective dose of SA that reduces the occurrence of intraoperative hypotension in elderly patients scheduled for major lower limb orthopedic surgery. Methods We conducted a systematic review of randomized controlled trials (RCTs) performed in elderly patients scheduled for surgical hip repair and a meta-analysis with meta-regression on the occurrence of hypotensive episodes at different effective doses of anesthetics. We searched PUBMED®, EMBASE®, and the Cochrane Controlled Clinical trials registered. Results Our search retrieved 2085 titles, and after screening, 6 were finally included in both the qualitative and quantitative analysis, including 344 patients 15% (10–28) males, with a median (25th to 75th interquartile) age of 82 (80–85). The risk of bias assessment reported “low risk” for 5 (83.3%) and “some concerns” for 1 (16.7%) of the included RCTs. The low dose of SA of mean 6.5 mg (1.9) anesthetic was associated with a lower incidence of hypotension OR = 0.09 (95%CI 0.04–0.21); p = 0.04; I 2 = 56.9%, as compared to the high-dose of anesthetic mean 10.5 mg (2.4). Conclusions In the included studies of this meta-analysis, a mean dose of 6.5 mg of SA was effective in producing intraoperative comfort and motor block and associated with a lower incidence of hypotension as compared to a mean dose of 10.5 mg. Trial registration CRD42020193627
Messina et al. (Sun,) conducted a meta-analysis in Hip fracture (n=344). Low dose spinal anesthesia vs. High dose spinal anesthesia (mean 10.5 mg) was evaluated on Incidence of intraoperative hypotension (OR 0.09, 95% CI 0.04-0.21, p=0.04). A low mean dose of 6.5 mg of spinal anesthesia significantly reduced intraoperative hypotension compared to a high mean dose of 10.5 mg (OR 0.09) in elderly patients undergoing hip fracture repair.
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