Spinal Anesthesia In Elderly Patients Research Articles

A Comparative Study of Infusion of Ephedrine and Phenylephrine on Hemodynamic Stability After Spinal Anesthesia in Elderly Patients Undergoing Lower Limb Orthopedic Surgeries.

Background Hypotension during spinal anesthesia occurs due to sympathetic nervous system blockade, resulting in decreased systemic vascular resistance and reduced cardiac output. Due to reduced sympathetic tone, peripheral arterial vasodilatation and blood pooling in lower limbs due to venodilatation occur, reducing preload to the heart and stroke volume. The elderly patients have reduced cardiovascular compensatory mechanisms, increasing the frequency and severity of hypotension due to sympathetic blockade after spinal anesthesia significantly. Vasopressors correct hypotension during the intraoperative period to maintain organ perfusion. Fluids can be administered, and if given excessively, can cause fluid overload and urinary retention. This study aimed to compare the effectiveness of vasopressors, phenylephrine, and ephedrine in maintaining hemodynamic stability intraoperatively through prophylactic infusion after spinal anesthesia in elderly patients for lower limb orthopedic surgeries. Methodology A total of 174 elderly patients aged 60 years and above with American Society of Anesthesiologists (ASA) Classification I and II, undergoing lower limb orthopedic surgeries, enrolled in a randomized comparative study, were allocated into three groups: Group P (phenylephrine, n=58) received 250 mcg phenylephrine in 30 ml normal saline using infusion syringe pump, Group E (ephedrine, n=58) received 30 mg ephedrine in 30 ml normal saline using infusion syringe pump, and Group C (control group, n=58) received mephentermine I/V (6 mg bolus) when the fall in blood pressure was below 30% of baseline without any placebo infusion. Hemodynamic parameters (systolic and diastolic blood pressure, mean arterial pressure (MAP), heart rate) at 15, 10, and 5-minute intervals before spinal anesthesia, and at 3, 6, 9, 12, 15, 20, 25, and 30-minute intervals after spinal anesthesia. The need for rescue doses to treat hypotension after spinal anesthesia was recorded. Result At all time intervals following spinal anesthesia, Group E reported heart rate and systolic blood pressure better than Groups P and C, significantly. At 3, 6, 9, 12, 15, and 25-minute intervals following spinal anesthesia, the diastolic blood pressure in Group E was enhanced significantlythan Groups P and C. The MAP in Group E was substantially higher than in other groups at 3, 6, 15, and 20-minute intervals following spinal anesthesia, which was statistically significant. Compared to Groups P and C, Group E required lesser rescue doses to treat intraoperative fall in hypotension 30% below baseline and lesser events of bradycardia. Conclusion Following spinal anesthesia, the preload to the heart is to be maintained with intravenous (crystalloid or colloidal) solutions to maintain cardiac output adequately. Intraoperative use of phenylephrine and ephedrine as a low-dose prophylactic infusion can be used, as it increases both systemic vascular resistance and preload without cardiac stimulation along with intravenous solutions to maintain hemodynamic parameters such as systolic and diastolic blood pressure, MAP, heart rate effectively but preferably ephedrine in elderly patients.

Effect of different anesthetic modalities on postoperative delirium in elderly hip fractures: A meta-analysis.

Previous findings on the effect of general versus spinal anesthesia on postoperative delirium in elderly people with hip fractures are somewhat controversial. This article included the latest randomized controlled study for meta-analysis to evaluate the effect of general anesthesia (GA) and spinal anesthesia (SA) on delirium after hip fracture surgery in the elderly, so as to guide the clinical. Cochrane Library, PubMed, Web Of Science, and Embase were searched from inception up to January 16, 2024. Randomized controlled trial (RCT) was included to evaluate the postoperative results of GA and SA in elderly patients (≥50 years old) undergoing hip fracture surgery. Two researchers independently screened for inclusion in the study and extracted data. Heterogeneity was assessed by the I²and Chi-square tests, and P < .1 or I² ≥ 50% indicated marked heterogeneity among studies. The Mantel-Haenszel method was used to estimate the combined relative risk ratio (RR) and the corresponding 95% confidence interval (CI) for the binary variables. Nine randomized controlled trials were included. There was no significant difference (RR = 0.93, 95% CI = 0.774-1.111, P > .05) in the incidence of postoperative delirium between the GA group and the SA group. In intraoperative blood transfusion (RR = 1.0, 95% CI = 0.77-1.28, Z = 0.04, P = .971), pulmonary embolism (RR = 0.795, 95% CI = 0.332-1.904, Z = 0.59, P = .606), pneumonia (RR = 1.47, 95% CI = 0.75-2.87, P = .675), myocardial infarction (RR = 0.97, 95% CI = 0.24-3.86, Z = 0.05, P = .961), heart failure (RR = 0.80, 95% CI = 0.26-2.42, Z = 0.40, P = .961), urinary retention (RR = 1.42, 95% CI = 0.77-2.61, Z = 1.11, P = .267) were similar between the 2 anesthetic techniques. There is no significant difference in the effect of GA and SA on postoperative delirium in elderly patients with hip fracture, and their effects on postoperative complications are similar.

Effects of Continuous Analgesic Titrated Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery

Background and Objectives: Anesthetizing elderly patients with hip fractures poses a significant challenge in emergency settings, particularly given the aging population both in Algeria and worldwide. With a high prevalence of comorbidities and polypharmacy, effective anesthetic management becomes paramount. Continuous titrated spinal anesthesia (CTSA) has emerged as a promising technique for addressing these complexities by proposing lower doses of local anesthetic (LA) in this patient population. Methods: This retrospective study involved 40 elderly patients (&gt;65 years) undergoing hip fracture repair. Patients received intermittent dosing of a local anesthetic solution via an intrathecal catheter, utilizing 0.25 ml increments of 0.5% isobaric bupivacaine and 0.25 ml of fentanyl (12.5 μg). Evaluation criteria included hemodynamic stability, incidence of hypotension, extent of sensory and motor blockade, total ephedrine consumption, and patient and surgeon satisfaction. Results: A female predominance was noted, with a mean age of 75 years, and 72% classified as ASA ≥ III. Pertrochanteric fractures accounted for 47% of cases, followed by femoral neck fractures at 53%. Nearly all patients achieved a sensory level ≥ D10, with a failure rate of only 2%. Sedation supplementation was required in 20% of cases, with conversion to general anesthesia in one patient. Complications were minimal, including arterial hypotension (3%), vasoconstrictor use (2%), and bradycardia (0.8%). Overall, both patients and surgeons reported high levels of satisfaction. Conclusions: Our findings demonstrate that CTSA is an effective technique for elderly patients undergoing hip fracture repair, offering the advantages of reduced LA doses, excellent hemodynamic stability, and minimal side effects. Its simplicity and cost-effectiveness further enhance its appeal in clinical practice.

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Effect of sitting time on the vasopressor requirement in elderly patients after spinal anesthesia: A randomized controlled study

ABSTRACT Background Neuraxial anesthesia appears to be a highly recommended, well-accepted technique for minimizing perioperative adverse effects in elderly patients. This research was designed to compare the impact of sitting for one, three, and 5 min on ephedrine consumption following spinal anesthesia in the elderly. Methods This randomized, controlled, double-blinded trial was conducted on 66 patients above 65 years undergoing surgeries under spinal anesthesia. Patients were randomly assigned to three equal groups. Patients received spinal anesthesia and then sat before they began to lie down for 1 min in the sitting-1 group, 3 min in the sitting-3 group, and 5 min in the sitting-5 group. Results The most reduction of mean arterial blood pressure (MAP) is in the Sitting-1 group, followed by the Sitting-3 group, and finally, the Sitting-5 group (p < 0.05). The most needed ephedrine was in the sitting-1 group (10 patients), followed by the sitting-3 (6 patients) and then the sitting-5 group (one patient) (p < 0.05). The sensory level was significantly higher in the sitting-1 group, followed by the sitting-3 and then sitting-5 group (p < 0.001). Conclusions Sitting for 5 min after spinal anesthesia in elderly patients decreases the ephedrine requirement and maintains adequate sensory block for surgery.

Retracted: Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease.

[This retracts the article DOI: 10.1155/2022/9160145.].

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

Comparison of Mixed Reality-Assisted Spinal Puncture with Landmark-Guided Spinal Puncture by Novice Practitioners: A Pilot Study.

Performing spinal anaesthesia in elderly patients with ligament calcification or hyperostosis is challenging for novice practitioners. This pilot study aimed to compare the effectiveness of mixed reality-assisted spinal puncture (MRasp) with that of landmark-guided spinal puncture (LGsp) by novice practitioners in elderly patients. In this pilot study, 36 patients (aged ≥65 years) scheduled for elective surgery under spinal anaesthesia by anaesthesiology residents were included. Patients were randomly assigned to the MRasp group (n = 18) or the LGsp group (n = 18). The outcomes included the number of needle insertion attempts, redirection attempts, passes, the rate of successful first-attempt needle insertion, the rate of successful first needle pass, the spinal puncture time, the total procedure time, and the incidence of perioperative complications. The median number of needle insertion attempts was significantly fewer in the MRasp group than in the LGsp group (1.0 vs 2.0, P = 0.023). The proportion of patients with successful first-attempt needle insertion was 72.2% in the MRasp group and 44.4% in the LGsp group (P = 0.176). The incidence of perioperative complications did not significantly differ between the two groups. This pilot study found that novice practitioners made significantly fewer needle insertion attempts in the MRasp group compared to the LGsp group when performing spinal anaesthesia on elderly patients. A future randomized controlled trial (RCT) is warranted to validate its effectiveness. This trial was registered at https://www.chictr.org.cn/showproj.html?proj=178960 (ChiCTR-IPR-2300068520). Public title: Mixed reality-assisted versus landmark-guided spinal puncture in elderly patients: a randomized controlled pilot study. Principal investigator: Lei Gao. The registration date was February 22, 2023. The date of the first participant enrolment was February 27, 2023.

Comparative Study between Dexmedetomidine Infusion Combination with Ketamine versus Fentanyl for Analgesia for Positioning of Spinal Anesthesia in Elderly Patients with Proximal Femoral Fracture

Abstract Background One of the main objectives of anesthesia is to alleviate the patient’s pain and agony, by ensuring the performance of surgical procedures without any discomfort. Spinal anesthesia is preferred in anesthesia of fracture femur surgeries. But the problem is positioning of the patient for spinal anesthesia as the patient is in agony and pain. In our study we chose dexmedetomidine for this goal. We preferred to add an adjuvant to limit side effects of dexmedetomidine and to control pain beside sedation. 70 patients with proximal femoral fracture were blinded and randomized divided into two groups dexmedetomidine ketamine (k) and dexmedetomidine fentanyl (f) each group has 45 patients. There is significant better analgesic effect and sedation of k group than f group. But no significant difference on hemodynamics and postoperative complications. Objective The objective of this study is to compare the analgesic effect of combination of ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture. Patients and Methods We aimed by our study to compare the analgesic effect of combination of (ketamine and dexmedetomidine versus fentanyl and dexmedetomidine infusion for the pain caused by postural changes for spinal anesthesia in patients with proximal femoral fracture and we applied our study on 70 patients will be divided into two equal groups: Group k: will receive 1mg/kg of intravenous ketamine with loading dose of dexmedetomidine 1 μg/kg over 10 minutes and Group F : will recieve 1 μg/kg of intravenous fentanyl with loading dose of dexmedetomidine 1 μg/kg over 10 minutes, with the same inclusion and exclusion criteria. then dexmedetomidine infusion only will continued at 0.6 μg/kg/h for following 20 minutes, and titrated at rate of 0.2 to 0.6 μg/kg/h until the end of surgery. Results The results of this study revealed that the pain score in lateral position was significally lower in k group than f group (0-1 vs 2-3); p &amp;lt; 0.001. and pain score during hip flexion was significally lower in k group than f group (0-1 vs 2-3 ) respectively p &amp;lt; 0.001. sedation level was much higher in k group than f group (3-4 vs 2-3) p value 0.023. But both groups shows equivalent effect on hemodynamics after dexmedetomidine administration. hypotension, Bradycardia and desaturation was common i in both groups. Regarding post operative complications no significant difference between both groups while incidence of delirium in k group (17.1%) is higher in comparison to f (11.4%) group but not significally difference. Conclusion the combination of dexmedetomidine ketamine is a good choice for analgesia of the pain during spinal anesthesia in elderly with fracture femur but need further assessment for dosage and regimen of administration and for better evaluation of the hemodynamic effects

Sitting against Lateral Position for Spinal Anaesthesia in Elderly Patients Undergoing Lower Limb Surgeries: An Observational Study

Introduction: Age-related degenerative anatomical changes may make the spinal anaesthesia difficult. Sitting position is preferable due to easy identification of landmarks whereas lateral position is easy to maintain in case of elderly premedicated patients. Aim: To compare the effects of spinal anaesthesia position (sitting versus lateral) in the elderly patients on block characteristics (sensory and motor), haemodynamic parameters, patient’s comfort and satisfaction. Materials and Methods: The present prospective observational study was conducted in the Department of Anaesthesiology and Intensive care, Adesh Institute of Medical Sciences and Research, Bathinda, Punjab, India, from November 2021 to May 2022. A total of 116 American Society of Anaesthesiologists (ASA) grade I-II patients of both sexes, age more than 70 years undergoing lower limb surgeries under spinal anaesthesia either sitting or lateral position were included in the study. These patients were divided in to two groups (sitting position-Group SP, lateral position-Group LP). Hyperbaric bupivacaine (0.5%) was injected into the subarachnoid space. After the spinal injection, assessments were made for block characteristics (sensory and motor), haemodynamic parameters and patient’s comfort and satisfaction. The discrete and categorical variables were analysed using Chi-square test. Results: The mean age of participants in Group SP and Group LP was 77.31±4.015 years and 76.69±4.901 years, respectively. Onset of sensory block after was significantly slower in Group SP (75.31±10.384 seconds) as compared to Group LP (64.23±7.758 seconds). Time required to achieve maximum level of sensory block was significantly higher in Group SP (8.11±1.416 minutes) than Group LP (6.67±1.324 minutes). There was no significant difference in Heart Rate (HR) in both groups, but there was significantly lower Systolic Blood Pressure (SBP) in Group SP than Group LP up to 12 minutes after spinal injection. However, the lateral position appears to be more comfortable for elderly patients as per the comfort score. Conclusion: Position for spinal anaesthesia, either sitting or lateral, has insignificant effects on block characteristics or on haemodynamic parameters except there was faster onset of sensory and motor block and more comfort in lateral position.

Comparison of general vs spinal anesthesia for direct anterior approach total hip arthroplasty in elderly patients: a retrospective study

Aim: It remains unclear whether spinal anesthesia is beneficial instead of general anesthesia in total hip arthroplasty (THA) performed via the direct anterior approach (DAA) in elderly patients. The aim of the present research was to investigate the safety and effectiveness of SA in elderly patients underwent DAA-THA. Materials and Methods: We made a retrospective analysis of 166 elderly patients underwent DAA-THA between January 2018 and December 2021. Patients were divided into two groups: general anesthesia (group GA, n=88) and spinal anesthesia (group SA, n=78). We compared the two groups regarding to 90-day readmission rate, amount of bleeding, blood product transfusion, length of hospital stays (LOS), major adverse cardiac events (MACE), postoperative pulmonary complications (PPC), and intensive care unit (ICU) requirement. We also recorded the demographics and procedure data of the two groups. Results: Ninety-day readmission rate, PPC, and ICU requirement in group SA were significantly lower than group GA (p&lt;0.05). There was no statistical difference between the two groups in terms of amount of bleeding, blood product transfusion, MACE, and LOS. Conclusion: Spinal anesthesia in elderly patients underwent DAA-THA may reduce 90-day readmission rate, PPC, and ICU requirement without increasing amount of bleeding, blood product transfusion, MACE, and LOS.

Dual- vs. Single-Plane Ultrasonic Scan-Assisted Positioning during Lumbar Spinal Puncture in Elderly Patients: A Randomized Controlled Trial.

The purpose of this study was to investigate the ability of single- versus dual-plane ultrasound scan-assisted spinal anesthesia techniques to improve the success rate and efficacy of spinal anesthesia in elderly patients undergoing lower extremity surgery. A total of 120 elderly patients undergoing lower extremity surgery were randomly assigned to either receive single-plane (Group A) or dual-plane ultrasonic scan-assisted spinal anesthesia (Group B). The primary outcome analyzed by this study was first-attempt success rate. Secondary outcomes analyzed included number of needle insertion attempts, needle redirections, locating time, procedural time, total time, puncture depth, quality of ultrasound images, level of block, adverse reactions, and complications. The first-attempt success rate was significantly higher in Group B compared to Group A (88.3% vs. 68.3%, p = 0.008). In comparison with Group A, the number of needle insertion attempts (1 (1–2) vs. 1 (1–1), p = 0.005) and needle redirections (2 (1–3) vs. 1 (0–2), p < 0.001) were both significantly lower in Group B; Group B also had a shorter procedural time (249.2 ± 30.1 vs. 380.4 ± 39.4 s, p < 0.001) but a longer locating time (250.1 ± 26.2 vs. 137.8 ± 13.5 s, p < 0.001). The dual-plane ultrasonic scan-assisted spinal anesthesia technique warrants consideration for application in elderly patients.

Clinical Observation of General Anesthesia Combined with Spinal Anesthesia in Elderly Patients with Chronic Obstructive Pulmonary Disease.

Objective This work is aimed at evaluating the efficacy and safety of general anesthesia (GA) combined with spinal anesthesia (SA) (GA+SA) in elderly patients with chronic obstructive pulmonary disease (COPD). Methods and Material. 50 elderly COPD patients were rolled randomly into a control group (simple GA) and observation group (GA+SA). The differences in operation time, postoperative recovery time (PRT), language expression time (LET), anesthetic dosage (AD), catheter extubation time (CET), respiratory circulation indicators (mean arterial pressure (MAP), heart rate (HR), SaO2, and PaO2), postoperative VRS score, pulmonary function (forced vital capacity (FVC)), forced expiratory volume in 1 s (FEV1)/FVC and forced expiratory flow (FEF 25%~75%), serum inflammatory factors (IL-6, IL-8, and TNF-α), Short Portable Mental Status Questionnaire (SPMSQ) score, and the incidence of respiratory system events were analyzed. Results The results showed that the PRT, LET, AD, and CET of the observation group were all shorter (P < 0.05). The postoperative MAP, HR, SaO2, and PaO2 levels of patients who received GA+SA were much higher than those who received simple GA (P < 0.05). The postoperative VRS score of the observation group was better than that of the controls (P < 0.05). The postoperative pulmonary function of patients in the observation group was better compared with that in the control group (P < 0.05). The postoperative serum inflammatory factors in the observation group were lower in contrast to the patients who received simple GA (P < 0.05). The postoperative cognitive function SPMSQ score of patients who received GA+SA was lower compared with the score of patients who received simple GA (P < 0.05). However, the probability of respiratory system events in the observation group was lower (P < 0.05). Conclusion In conclusion, GA+SA could significantly shorten the PRT and improve the recovery quality of elderly COPD patients. It can also reduce the postoperative inflammatory response and strengthen the pulmonary function and cognitive function. It also enhances the analgesic which is beneficial to patients' postoperative recovery. Therefore, GA+SA was a highly effective and safe anesthesia method for elderly patients with COPD, and it was worthy of clinical application.

Dose Selection of Ropivacaine for Spinal Anesthesia in Elderly Patients with Hip Fracture: An Up-Down Sequential Allocation Study.

ObjectiveThe dose selection of ropivacaine for spinal anesthesia in clinical work mainly depends on the experience of the anesthesiologist. In this study, a prospective and modified up-down sequential allocation design was used to provide the optimal dose selection of ropivacaine for spinal anesthesia.Patients and methodsThis study was divided into two stages, and a total of 164 elderly patients with elective hip fractures were included. In stage I, the dose of ropivacaine was selected using the up-down sequential method of height correction, and the 50% effective dose (ED50) and 95% effective dose (ED95) were obtained. A nomogram for predicting satisfactory anesthesia and a formula for predicting the optimal dose was also given in this stage. In stage II, the dose of ropivacaine was calculated by using the optimal dose prediction formula, so as to evaluate the efficacy and safety of the model.ResultsThe ED50 and ED95 of the stage I were 7.036 mg (95%CI 6.549–7.585 mg) and 8.709 mg (95%CI 7.902–14.275 mg), respectively. And provided a nomogram predicting satisfactory anesthesia with a C-index of 0.847 (95%CI 0.774–0.92). The optimal dose prediction formula of ropivacaine was calculated, including variables for age, gender, height, and weight. This formula was found to be 90% efficient. It is worth mentioning that the incidence of direct transfer to the ward in the two stages was as high as 86.84% and 93.33%, respectively, and no patients were transferred to the ICU in stage II.ConclusionThe ED50 and ED95 of ropivacaine were 7.036 mg and 8.709 mg, respectively, and the nomograms are sufficiently accurate to predict satisfactory anesthesia. Beyond that, the dose prediction equation provided in this study has high efficacy and safety, and can guide the dose selection of spinal anesthesia in elderly patients with hip fracture in clinical practice.Clinical trials registrationChiCTR2100046982

A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture

Background &amp; objective: Spinal anesthesia (SA) is preferred for fractured femur surgery but it requires proper positioning which is often very difficult to achieve due to pain. Different methods have been used to control the pain during patient positioning, but the results are inconsistent about the superiority of one over the other. We compared femoral nerve block (FNB) and intravenous ketamine for pain control during positioning for SA in elderly patients with femur fracture.&#x0D; Methodology: A total of 66 patients above 60 y of age were randomly divided into two equal groups; FNB group to receive ultrasound guided FNB with 15-20 ml of bupivacaine 0.25% and ketamine group to receive IV ketamine 0.25 mg/kg. Assessment of VAS scores during positioning before SA was done. Rescue analgesia for pain during positioning was achieved by inj fentanyl IV, and after the surgery by inj morphine IV. Postoperative VAS scores, calculation of total morphine consumption during the first 24 h and any complications were recorded.&#x0D; Results: The VAS score during positioning was lower in FNB group compared to ketamine group (P &lt; 0.001). This was evident by lower recorded doses of pre-spinal rescue fentanyl. FNB group showed better postoperative analgesia, less morphine consumption and less complications.&#x0D; Conclusion: FNB provided better analgesia during positioning for spinal blockade in fractured femur patients. Furthermore, FNB was associated with less adverse effects, better postoperative analgesia and less opioid consumption.&#x0D; Trial Registry: PACTR202112605652525.&#x0D; Abbreviations: SA - Spinal anesthesia; FNB - Femoral nerve block; NSAIDS - Nonsteroidal anti-inflammatory drugs; VAS - Visual Analog Scale&#x0D; Key words: Pain; Spinal anesthesia; Femoral nerve block; Ketamine; Femur surgery&#x0D; Citation: Moussa MEM, Awad HGS, Hamid HSA, Abdellatif AE, Sharaf AGS. A comparative study between femoral nerve block and intravenous ketamine for pain management during positioning for spinal anesthesia in elderly patients with femur fracture. Anaesth. pain intensive care 2022;26(3):297-303.&#x0D; DOI: 10.35975/apic.v26i3.1895&#x0D; Received: January 25, 2022, Reviewed: March 16, 2022, Accepted: March 23, 2022&#x0D;

Comparison of Effects between Combined Lumbar-Sacral Plexus Block plus General Anesthesia and Unilateral Spinal Anesthesia in Elderly Patients Undergoing Hip Fracture Surgery: A Pilot Randomized Controlled Trial.

Purpose Hip fracture is a common injury in geriatric populations, which is associated with poor quality of life. However, the ideal anesthesia technique for this disease is yet to be identified. This study aimed to compare the combined lumbar-sacral plexus block (CLSB) plus general anesthesia (bispectral index (BIS) 60–80) with the unilateral spinal anesthesia (SA) on activity of daily living in elderly patients undergoing hip fracture surgery. Methods A total of 124 elderly patients undergoing hip fracture surgery were randomly assigned to two groups. Patients in the SA group received light-specific gravity spinal anesthesia, and patients in the CLSB group received lumbar and sacral plexus block with general anesthesia (BIS 60–80). The primary outcomes were 30-day activity of daily living (ADL). The secondary outcomes were postoperative pain scores, postoperative delirium, in-hospital cost, and major complications. Results The ADL scores of postoperative day 30 (POD30) in the CLSB group are higher than those in the SA group (27.34 ± 7.01 versus 24.70 ± 6.40, P=0.045). Compared to preoperative ADL scores, there were higher increased scores in the CLSB group than in POD30 (CLSB group 8.09 ± 3.39 versus SA group 4.87 ± 3.90, P < 0.001). Mild-to-moderate pain did not have differences between the two groups (rest pain: 3 versus 2, P=0.344; motion pain: 5 versus 4, P=0.073). There were no significant differences in incidence of postoperative delirium, PONV, and other complications. Conclusion The unilateral SA can reduce the deterioration of ADL after hip fracture surgery and provide a better postoperative recovery.

Preprocedural Ultrasonography Versus Landmark-Guided Spinal Anesthesia in Geriatric Patients with Difficult Anatomy: A Prospective Randomized Trial.

This study was aimed to determine whether preprocedural ultrasonography (USG) affects the technical performance of spinal anesthesia in elderly patients with difficulty in palpating landmarks, scoliosis, or previous spine surgery. This prospective study was conducted in 156 elderly patients scheduled for elective orthopedic lower extremity surgery. The patients were randomly divided into 2 groups to receive spinal anesthesia by the preprocedural USG examination (group U) or conventional landmark palpation technique (group P). The primary finding of our study was the rate of successful access to the subarachnoid space on initial needle insertion attempt. Secondary achievements included number of needle insertion attempts, number of needle redirections, total procedure time, needle pain scores, patient satisfaction, and complications of spinal anesthesia. The rate of successful access to the subarachnoid space at the first needle insertion attempt was significantly higher in group U than in group P (74.4% vs 53.8%, p=0.008). Medians (interquartile range) of both needle insertion attempts (group P, 2 [1-3] vs group U, 1 [1-2]; p=0.038) and needle redirections (group P, 3 [2-5] vs group U, 2 [1-4]; p=0.028), requiring to achieve dural puncture, were significantly higher among the patients in group P than those in group U. No statistically significant difference was found between the groups regarding total procedure time, pain scores, patient satisfaction scores, and spinal anesthesia-induced complications (p>0.05). Our study findings showed that preprocedural neuroaxial USG improves technical performance of spinal anesthesia in elderly patients with difficult anatomy.

Response of unilateral spinal anaesthesia in elderly patients admitted to BMC &amp; Allied Teaching Hospital in District BANNU-KPK.

Objectives: The objective of this study was to investigate the possible restriction effects of unilateral spinal anaesthesia on sympathetic block to evade unwanted cardiac effects in elderly patients. Study Design: Cross section study. Setting: Department of Surgery, BMC Allied Teaching Hospitals District Bannu-KPK. Period: June 2018 to January 2020. Material &amp; Methods: In this study, 30 ASA III and ASA IV male adults having an age 55-65 and receiving lower limb surgery were included. The patients were given unilateral spinal anaesthesia (using 0.5% Bupivacaine). All the subjects were maintained in a lateral position having their operated side downwards and were kept in position for a period of 15 minutes. The assessment of the sensory and motor nerves was done, and hemodynamic changes were recorded following spinal anaesthesia. The monitoring was done for half an hour. Results: The observed hemodynamic effects in elderly patients were minimum which demonstrated the effectiveness of unilateral spinal anaesthesia in limiting the sympathetic block, evading the unwanted cardiac effects thus providing high cardiovascular stability. It was observed that the preparation time required for unilateral spinal anaesthesia was a bit longer as compared to conventional method. The technique also proved to be acceptable for patients with an elevated autonomy following surgical procedure and lesser urine retention. Conclusion: When unilateral spinal anaesthesia was administered in admitted patients using lower flow injection method and low volume, stable hemodynamic results were achieved. Patients were more satisfactory. Thus, unilateral spinal anaesthesia is effective in limiting the sympathetic block in old age patients.

The effects of sedation with propofol and propofol-ketamin combination on postoperative cognitive function in elderly patients undergoing spinal anesthesia

Aim: Elderly patients frequently require surgery. Postoperative cognitive dysfunction (POCD) is an adverse event and reduces thepatient’s quality of life. We aimed to compare the effects of sedation applied with propofol or propofol-ketamine (ketofol) combinationon hemodynamics and POCD during spinal anesthesia in elderly patients undergoing urological surgery.Materials and Methods: Study was performed on 60 ASA I-III patients over 65 years of age. Before the operation (standardizedMini Mental Test) sMMT was applied by a blind researcher. The cases were randomly divided into two groups as propofol (Group P,n=30) and ketofol (Group K, n=30). ECG, SpO 2 , Bispectral Index (BIS), noninvasive blood pressure (NIBP) was monitored. After spinalanesthesia, group P received propofol 0.5 mg/kg IV bolus and then 1.5 mg/kg/hour infusion. Group K received propofol 0.4 mg/kg and ketamine 0.1 mg/kg IV bolus and then propofol 1.2 mg/kg/hour and ketamine 0.3 mg/kg/hour infusion. Hemodynamic andrespiratory data were recorded. The sedation level was monitored by RAMSAY sedation score. sMMT was repeated by the researcherwho performed the initial test at postoperative first 24 hours and postoperative 3rd day.Results: Significant decreases were observed for heart rate, SAP, and MAP in both groups compared with baseline values. Nostatistically significant difference was detected between the groups in sMMT values at postoperative 1 st and 3 rd days. Within-group comparisons revealed significant differences between preoperative sMMT and postoperative 1 st day sMMT and betweenpostoperative 1 st and postoperative 3 rd day sMMT (p< 0.001). No difference was detected between preoperative and postoperative3 rd day sMMT (p< 0.25). In Group P, there was statistically significantly higher injection pain (p<0.05).Conclusion: In this study we found that the recovery period of the patients was longer and BIS values were higher in group K, but nosignificant difference could be found in hemodynamic and cognitive functions.

A study to evaluate the effect of low dose Intrathecal dexmedetomidine as adjuvant to low dose bupivacaine (H) Spinal Anaesthesia in elderly patients undergoing Infraumbilical Surgery

Background: Elderly patients pose a serious challenge to anaesthesia not only because of associated co-morbidities but also due to physiological changes during aging. Therefore lower doses of local anesthetics along with Intrathecal a2-adrenoceptor agonists have been shown to decrease the required doses of local anesthetics and are devoid of major side effects. Hence this study evaluates spinal anaesthesia characteristics in elderly patients. Methods: 120 Patients aged more than 60 years belonging to ASA I,II and III physical status and posted for infraumbilical surgeries were randomized into 2 groups, Group B(Bupivacaine) and Group BD (Bupivacaine + Dexmedetomidine) .Under aseptic conditions lumbar puncture was performed in sitting position at L3-4 / L4-5 interspace and 2.1 ml of study agents were administered. Group B received 10mg of 0.5% hyperbaric Bupivacaine and Group BD received 10mg of 0.5% hyperbaric Bupivacaine and 5mcg of Dexmedetomidine. In all cases monitoring of Blood pressure, ECG, Oxygen saturation and Respiratory rate was done at regular intervals intra-operatively. Sensory block and motor blocks were assessed periodically. Results: There were no clinically and statistically significant changes in heart rate and blood pressure and the mean max fall in HR, SBP, DBP and MAP. However, it was observed that there was a statistically significant (P<0.001) decrease in the time of onset of sensory block and motor block in Group BD(1.68±0.96 and 2.42±1.12) when compared to Group B(2.24±0.81 and 3.33±1.06) . Duration of analgesia and the time for first rescue analgesia was prolonged in Group BD (P<0.001). There were no side effects except for mild sedation in Group BD. Conclusion: Addition of Dexmedetomidine 5 mcg to intrathecal Bupivacaine(H) in elderly patients causes minimum hemodynamic changes, prolongs sensory and motor block.