Low dose of isobaric bupivacaine provides lower incidence of spinal hypotension for hip surgery in elderly patients
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Background and Objectives: Spinal anesthesia for surgical repair of hip fracture in the elderly is associated with a high incidence of hypotension. The aim of this study was to compare the hemodynamic effects of a single injection of low dose (7.5 mg) versus full dose (15 mg) of isobaric bupivacaine. Methodology: Fifty patients older than 60 years undergoing surgery for hip fracture were randomly divided into two groups of 25 patients. For spinal anesthesia, Group 1 received 15 mg of 0.5% isobaric bupivacaine and Group 2 received 7.5 mg of the same solution. Hypotension was defined as SBP decrease > 30% of the pressure in nursing and would be dealt with ethylephrine bolus of 2 mg. Results: All patients showed satisfactory spinal anesthesia. With 15 mg four patients required one dose of ethylephrine and one patient required two doses to correct hypotension. In the group with 7.5 mg no patient developed hypotension. The lower dose reflected in significantly less cephalad spread, less motor block and shorter PACU stay. Conclusions: The dose of 7.5 mg of isobaric bupivacaine for spinal anesthesia provides sufficient level of analgesia for surgical correction of hip fractures in elderly patients, eliminating the need for the use of vasopressor.