Rachianesthésie à la bupivacaïne pour chirurgie de la hanche chez le vieillard

Abstract

In 60 elderly patients, spinal anaesthesia for orthopaedic hip surgery was induced randomly with 15 mg bupivacaine 0.375 % without glucose (Group I), 2.5 % glucose (Group II) or 7.5 % glucose (Group III), in 4 ml. The injection was made in the lateral position, and the patients turned supine immediately after. The onset, extent and duration of sensory and motor blockade, the cardiovascular effects and the quality of anaesthesia were evaluated. The hyperbaric solutions produced a greater cephalad spread of analgesia (T8,9 and T9,8 respectively) than the glucose-free solution (T10,5). The mean duration of analgesia at the L2 level with the isobaric solution was significantly greater : 187 min versus 171 min and 150 min with the hyperbaric solutions. All the patients had complete motor blockade of the lower limb. The mean duration of the motor block was significantly shorter for the 2.5 % and 7.5 % glucose solutions (137 and 125 min respectively for Bromage's degree 3) versus 170 min for the glucose-free solution. Although the pre-anaesthetic arterial pressures in the three groups did not differ significantly, the systolic, mean and diastolic arterial pressures decreased only by about 20 to 25 % in all groups. It was suggested to take into account the more rapid infusion of lactated Ringer's solution (20 ml · kg −1) in Group III. Anaesthesia was satisfactory in 95 % of patients in Group I and Group II, and 90 % in Group III. Glucose-free bupivacaine produced a long-lasting blockade suitable for hip surgery of long duration.