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

Anesthesia and analgesia, 2022-09, Vol.135 (6), p.1262-1270 [Peer Reviewed Journal]

Distributed under a Creative Commons Attribution 4.0 International License ;ISSN: 0003-2999 ;EISSN: 1526-7598 ;DOI: 10.1213/ANE.0000000000006208

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  • Title:
    Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial
  • Author: 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
  • Subjects: Statistics
  • Is Part Of: Anesthesia and analgesia, 2022-09, Vol.135 (6), p.1262-1270
  • Description: BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
  • Publisher: Lippincott, Williams & Wilkins
  • Language: English
  • Identifier: ISSN: 0003-2999
    EISSN: 1526-7598
    DOI: 10.1213/ANE.0000000000006208
  • Source: GFMER Free Medical Journals
    Alma/SFX Local Collection
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