The Effect of Different Combination Doses of Intrathecal Hyperbaric Bupivacaine 0.5% and Sufentanil on the Hemodynamic Profile of Geriatric Patients Undergoing Hip Surgery under Spinal Anesthesia

With the increasing number of elderly patients with fragile hemodynamic profiles undergoing lower limb surgery, avoiding hypotension in this population is of great importance. We intended to study the effect of different combination doses of intrathecal hyperbaric bupivacaine 0.5% and sufentanil on the hemodynamic profile of geriatric patients undergoing lower limb surgery.
A total of 60 patients aged over 70, candidates for lower limb surgery under spinal anesthesia were enrolled in this study. The patients were randomly allocated into three groups. Group 1 (G1: 5 mg bupivacaine plus 10 µg sufentanil intrathecally), Group 2 (G2: 10 mg bupivacaine plus 5 µg sufentanil intrathecally), and Group 3 (G3: 15 mg bupivacaine intrathecally). Non-invasive automated blood pressure was checked every 1 minute for the first 5 minutes, and every 5 minutes for 25 minutes and every 15 minutes for 30 minutes during surgery. Heart rate (HR) was recorded at the same intervals. The quality of the blocks was also compared.
A total of 60 patients met the inclusion criteria and were enrolled in the study. Five patients had failed spinal anesthesia whom were replaced with new patients. There was no difference between the groups in their baseline characteristics. Mean arterial pressure after 1 minute in Groups 2 and 3 was significantly lower than Group 1 (86.0 ± 9.0, 87.3 ± 11.0, 92.2 ± 13.0, P = 0.001). No statistically significant difference in HR was observed in between the three groups. The degree of motor and sensory block was adequate in all three groups, and no patients required any additional analgesics. 15 (75%) patients in Group 3 received ephedrine in comparison to 11 (55%) patients in Group 2. 3 (15%) patients in group one needed ephedrine.
In conclusion, adding sufentanil as an adjuvant and decreasing the dose of intrathecal hyperbaric bupivacaine may help maintain a stable hemodynamic during lower limb surgery in the elderly.