Single-shot spinal anesthesia with heavy bupivacaine in two regimens versus continuous spinal anesthesia in elderly patients undergoing hip surgery: a prospective randomized controlled study

Abstract

Background Elderly patients with hip fracture are a medical challenge. Spinal anesthesia (SA) is effective, rapid, has minimal effect on mental status, reduces blood loss, and thromboembolic complications. The continuous spinal anesthesia (CSA) produces more sensory–motor blockade with fewer hemodynamic effects. Intrathecal opioids can achieve successful SA using decreased doses of local anesthetics. Aim The aim of this study is to compare the safety and the efficacy of single-shot SA with heavy bupivacaine in two regimens versus continuous SA in elderly patients undergoing hip surgery. Patients and methods This study was carried out on 60 patients aged 65 years or older patents scheduled for hip surgery. Patients were randomized into three groups (n=20): group A SA with hyperbaric bupivacaine 7.5 mg, group B spinal fentanyl anesthesia (SFA) SA with hyperbaric bupivacaine 5 mg+25 μg fentanyl, and group C (CSA) with continuous SA. Heart rate (HR), mean arterial pressure (MAP), onset, duration, and the level of sensory block and onset, duration and score of motor block were recorded. Complications, amounts of fluids, and/or blood products and the use of vasopressors, total doses of bupivacaine, need for sedation, supplementation, and anesthetic failure were recorded. Assessment of pain was done using by visual analog score for 6 h postoperatively. Results MAP showed significant decrease in group A. The onset of sensory block and time to reach T10 showed significant increase in group C. Time of regression of sensory block T12 showed significant decrease in group C. The onset of motor block showed significant increase in group C. The duration of the motor block showed significant decrease in group C. Scores of motor block in the three groups show insignificant difference. Conclusion CSA had the advantage of being significantly hemodynamically stable and lower dose of local anesthetics and ephedrine than SA. Besides, intrathecal opioids improve the quality of spinal block.