Rachianesthésie hypobare unilatérale chez le sujet âgé pour la chirurgie traumatique de la hanche : étude pilote

Abstract

Introduction. – Fractured neck of femur is encountered more frequently as life expectancy increases. All anaesthetic techniques aim to avoid deleterious fall in arterial blood pressure. The haemodynamic effects of hypobaric unilateral spinal anaesthesia have been rarely assessed in patients over 80 year’s old. This study aims to do that in a prospective manner.Patients and methods. – Twenty-five patients were enrolled. Following a preload with HES 240/0.576 % (Hesteril®) (5 ml/kg) and the administration of an iliofascial block, patients were placed in the lateral decubitus position, operative side uppermost. 3.5 ml of 0.12% hypobaric bupivacaine was administered intrathecally at a rate of 0.25 ml/secondes. Patients were kept in position for 15 minutes. Systolic, mean and diastolic arterial pressures, heart rate, SaO2 % and ephedrine consumption were recorded at five minutes intervals as was the rate of onset, height and duration of sensory and motor block and extent of bilateralization. Patient and surgeon satisfaction scores were also recorded.Results. – No significant changes in systolic, mean and diastolic pressures, or SaO2 % occurred. Median onset times of sensory and motor block were 8±5 and 16±7 minutes on the operative side and 30±15 and 36±15 minutes on the contralateral side in those with bilateralization, respectively. The maximum height of sensory block was T6 for sept patients, T8 for huit patients and T8–T10 for the remainder. Mean duration of sensory and motor block was 134±26 and 119±24 minutes on the operative side and 100±26 and 98±25 minutes on the contralateral side, respectively. In 12 patients (48%) bilateralization of their block occurred. Patients and surgeons rated the technique highly.Conclusion. – Hypobaric unilateral spinal anaesthesia is a simple technique, produces satisfactory operative conditions and induces very little haemodynamic change in the elderly population.