Spinal anesthesia with 9.0 mg glucose-free bupivacaine and 20 microg fentanyl reduced the incidence of hypotension compared to 11.0 mg bupivacaine alone, but resulted in more failed blocks (4 vs 1).
Does 9.0 mg glucose-free bupivacaine with added fentanyl 20 microg reduce hypotension compared to 11.0 mg glucose-free bupivacaine alone in elderly patients undergoing spinal anaesthesia for hip fracture repair?
Adding fentanyl to a reduced dose of bupivacaine for spinal anesthesia in elderly hip fracture patients reduces intraoperative hypotension but may increase the risk of failed blocks.
Intraoperative hypotension is a common and potentially deleterious event in elderly patients undergoing spinal anaesthesia for repair of hip fractures. The synergism between intrathecal opioids and local anaesthetics may allow a reduction in the dose of local anaesthetic and cause less sympathetic block and hypotension, while still maintaining adequate anaesthesia. We studied 40 elderly patients having either an insertion of a dynamic hip screw or a hemiarthroplasty and compared 9.0 mg glucose-free bupivacaine with added fentanyl 20 microg (group BF) with 11.0 m glucose-free bupivacaine alone (group B). Hypotension was defined as a fall in systolic blood pressure to less than 75% baseline or less than 90 mmHg. The incidence and frequency of hypotension in group BF were less than in group B. Similarly, falls in systolic, diastolic and mean blood pressures were all less in group BF than in group B. However, there were four failed blocks in group BF and one in group B.
Martyr et al. (2005) studied Hip fracture requiring spinal anaesthesia (n=40). Glucose-free bupivacaine with fentanyl vs. 11.0 mg glucose-free bupivacaine alone was evaluated on Hypotension (fall in systolic blood pressure to less than 75% baseline or less than 90 mmHg). Spinal anesthesia with 9.0 mg glucose-free bupivacaine and 20 microg fentanyl reduced the incidence of hypotension compared to 11.0 mg bupivacaine alone, but resulted in more failed blocks (4 vs 1).