Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial

Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to genera...

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Veröffentlicht in:Anesthesia and analgesia Jg. 135; H. 6; S. 1262
Hauptverfasser: Simonin, Marine, Delsuc, Claire, Meuret, Pascal, Caruso, Liana, Deleat-Besson, Robert, Lamblin, Antoine, Huriaux, Laetitia, Abraham, Paul, Bidon, Cyril, Giai, Joris, Riche, Benjamin, Rimmelé, Thomas
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States 01.12.2022
Schlagworte:
Aged
Anesthesia, General - adverse effects
Anesthesia, Spinal - adverse effects
Bupivacaine
Hip Fractures - surgery
Humans
Hypotension - chemically induced
Hypotension - diagnosis
Prospective Studies
ISSN:1526-7598, 1526-7598
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Zusammenfassung:Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7-11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
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ISSN:1526-7598
1526-7598
DOI:10.1213/ANE.0000000000006208