Unilateral continuous spinal anesthesia with hypobaric bupivacaine in elderly patients undergoing hip replacement / 中华麻醉学杂志

ABSTRACT

Objective To explore the feasibility of using unilateral continuous spinal anesthesia (CSA) in elderly patients undergoing hip replacement.Methods Forty-two ASA Ⅰ-Ⅲ patients (14 males, 28 females) aged 60-93yr were randomized to one of two groups group 1 unilateral CSA (n = 21) and group 2 continuous epidural anesthesia (CEA,n = 21 ) . The patients in both groups were all premedicated with oral diazepam 5 mg and intramuscular scopolamine 0.3 mg. In group 1 unilateral CSA was performed at L2,3 or 3,4 interspace with the patients in the lateral position with the diseased leg upper most. The patients received a 27 gauge continuous spinal catheter, which was threaded through a 22 gauge spinal needle into subarachnoid space. Hypobaric 0-375% bupivacaine solution (0.75 % bupivacaine sterile water = 11) 0.5-1.0ml was injected. If analgesia did not reach T10 after 5-10 min the same dose was repeated. In group 2 epidural catheter was placed also at L2.3or3,4. A test dose of 3 ml of 2% lidocaine was injected and then a mixture of 2% lidocaine and 0.5% bupivacaine (11) 8-10 ml was injected into the epidural space. The level of sensory block and degree of motor blockade were measured and recorded. The intraoperative and postoperative complications associated with spinal or epidural anesthesia were recorded. Results The demographic data, duration of operation and intraoperative blood loss were comparable between the two groups.In group 1 sensory block was confined to the diseased leg and no motor blockade of the healthy leg was observed. MAP was slightly decreased after initial dose of local anesthetics as compared to the baseline MAP in both groups. There was no significant change in SpO2 during operation in both groups. The incidences of hypotension, which needed treatment with intravenous ephedrine and shivering during operation and nausea and vomiting after operation were significantly lower in group 1 than in group 2. Conclusion Unilateral CSA produces satisfactory sensory block with stable hemodynamics and less complications and is anesthesia method of choice in elderly patients undergoing hip replacement.