Prevención de hipotensión posterior a anestesia epidural en cirugía de cadera.

"Dosis baja de bupivacaina con sufentanilo previene la hipotensión siguiente a la anestesia epidural para la reparación de cadera en pacientes de edad avanzada."

C. Olofsson E-B. Nygårds A-B. Bjersten A. Hessling

Abstract

Background:
Hip fracture is common in the geriatric population. Patients in this group are often at high risk for perioperative complications from concurrent diseases. Conventional spinal anesthesia can be associated with hypotension but has a better postoperative outcome compared to general anesthesia. We judged that a reduced dose of bupivacaine in combination with sufentanil could give reliable blocks with minimal hypotension.

Methods:
Fifty elderly patients were randomized into two groups. The study group received spinal anesthesia as a combination of hyperbaric bupivacaine 7.5 mg and sufentanil 5 µg while the control group received hyperbaric bupivacaine 15 mg. The hemodynamic stability of the patients and the quality of the blocks were compared.

Results:
All patients had adequate duration of reliable blocks. More control group patients than study group patients required ephedrine due to hypotension.

Conclusion:
A reduced dose of hyperbaric bupivacaine (7.5 mg) in combination with sufentanil (5 µg) provides reliable spinal anesthesia for the repair of hip fracture in aged patients with few events of hypotension and little need for vasopressor support of blood pressure.

Acta Anaesthesiologica Scandinavica. Volume 48: Issue 10. Page range: 1240 - 1244.