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  • Title: [Comparison of the hemodynamic response in subarachnoid anesthesia with bupivacaine versus bupivacaine with fentanyl in traumatology surgery in elderly patients].
    Author: Alonso Chico A, Cruz Pardos P, Alvarez Grau J, Pachoco Jiménez A, Arregui Martínez de Lejarza M, Sánchez García ML, Cardona Valdés A.
    Journal: Rev Esp Anestesiol Reanim; 2003 Jan; 50(1):17-22. PubMed ID: 12701260.
    Abstract:
    OBJECTIVES: To compare the intraoperative hemodynamic effects and ephedrine requirements in elderly patients undergoing orthopedic surgery under subarachnoid anesthesia with hyperbaric bupivacaine with or without fentanyl. MATERIAL AND METHODS: Sixty patients over 75 years of age and scheduled for semi-urgent surgical repair of a fractured femur were randomized to two groups. Group F received subarachnoid surgery with 5 mg of bupivacaine and 15 micrograms of fentanyl. Group B received 7.5 mg bupivacaine. We recorded blood pressure, heart rate and oxygen saturation every 5 minutes and extension of anesthesia. Hemodynamic changes and ephedrine required by each patient were analyzed, along with side effects. RESULTS: Group F patients were more hemodynamically stable 10 and 20 minutes after infusion of the anesthetic, and more hypotensive episodes occurred in group B. Group B consumed significantly more ephedrine (p < 0.05), administered to 22 patients in group B and 6 in group F. The total dose of ephedrine administered was greater in group B (190 mg) than in group F (40 mg). The extension of anesthetic block was sufficient for surgery in all cases. No side effects from fentanyl administration were observed. CONCLUSION: Adding fentanyl to the local anesthetic used for subarachnoid anesthesia in elderly patients is effective for maintaining greater hemodynamic stability, allowing use of a lower dose of hyperbaric bupivacaine and reducing the need for intravenous ephedrine during surgery.
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