Determination of the minimum initial intrathecal dose of isobaric 0.5% bupivacaine for the surgical repair of a proximal femoral fracture

Szücs, S; Rauf, Jassim; Iohom, Gabriella; Shorten, George

doi:10.1097/eja.0000000000000235

“…The injection time the mixture is given may have an effect on the hypotension severity and we await studies addressing this topic. In an interesting study by Szucs et al 29 they used the "up-and-down" method described by Dixon and Massey in 1969 to find the lowest intrathecal dose of local anesthetic to provide adequate anaesthesia for a hip fracture operation. 30 They concluded that 0.24 mL of 5 mg/mL isobaric bupivacaine was enough as a single dose but still recommended a dose of 0.4 mL or more i.e.…”

Section: Discussionmentioning

confidence: 99%

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Olsen

¹

,

Segerstad²,

Dalla³

et al. 2023

F1000Res

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Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.

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“…The injection time the mixture is given may have an effect on the hypotension severity and we await studies addressing this topic. In an interesting study by Szucs et al 30 they used the “up-and-down” method described by Dixon and Massey in 1969 to find the lowest intrathecal dose of local anesthetic to provide adequate anaesthesia for a hip fracture operation. 31 They concluded that 0.24 mL of 5 mg/mL isobaric bupivacaine was enough as a single dose but still recommended a dose of 0.4 mL or more i.e.…”

Section: Discussionmentioning

confidence: 99%

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Olsen,

Hård af Segerstad,

Dalla

et al. 2023

F1000Res

0

View full text Add to dashboard Cite

Background: Systemic haemodynamic effects of intrathecal anaesthesia in an aging and frail population has not been well investigated. We examined the systemic haemodynamics of fractional spinal anaesthesia following intermittent microdosing of a local anaesthetic and an opioid. Methods: We included 15 patients aged over 65 with significant comorbidities, planned for hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. All measurements were performed prior to start of surgery. Invasive mean arterial pressure (MAP), cardiac index (CI), systemic vascular resistance index (SVRI), heart rate and stroke volume index (SVI) were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15 µg were administered with 25-minute intervals. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHg. Results: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.01-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes following the first dose. CI, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the second dose, none of the systemic haemodynamic variables were affected. Conclusions: Fractional spinal anaesthesia administered prior to surgery induced a minor to moderate fall in MAP, mainly caused by a reduction in cardiac output, induced by systemic venodilation, causing a fall in venous return. Our results are contrary to the widely held belief that hypotension is mainly the result of a reduction of systemic vascular resistance.

show abstract

“…The injection time the mixture is given may have an effect on the hypotension severity and we await studies addressing this topic. In an elegant study by Szucs et al [27] they used the method "up-and-down" described by Dixon and Massey in 1969 to find the lowest intrathecal dose of local anesthetic to provide adequate anesthesia for a hip fracture operation [28]. They concluded that 0.24 ml of 5 mg/ml isobaric bupivacaine was enough as a single dose but still recommended a dose of 0.4 ml or more i.e.2 mg.…”

Section: Discussionmentioning

confidence: 99%

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Olsen¹,

Segerstad²,

Dalla³

et al. 2021

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Background: Aging and frailty make the elderly patients susceptible to hypotension following spinal anesthesia. The systemic hemodynamic effects of spinal anesthesia are not well known. In this study, we examine the systemic hemodynamic effects of fractional spinal anesthesia following intermittent microdosing of a local anesthetic and an opioid.Methods: We included 15 patients aged over 65 with considerable comorbidities, planned for emergency hip fracture repair. Patients received a spinal catheter and cardiac output monitoring using the LiDCOplus system. Invasive mean arterial pressure (MAP), cardiac index, systemic vascular resistance index, heart rate and stroke volume index were registered. Two doses of bupivacaine 2.25 mg and fentanyl 15µg were administered with 25 minutes in between. Hypotension was defined as a fall in MAP by >30% or a MAP <65 mmHgResults: The incidence of hypotension was 30%. Hypotensive patients (n=5) were treated with low doses of norepinephrine (0.003-0.12 µg/kg/min). MAP showed a maximum reduction of 17% at 10 minutes after the first dose. Cardiac index, systemic vascular resistance index and stroke volume index decreased by 10%, 6%, and 7%, respectively, while heart rate was unchanged over time. After the first dose, none of the systemic haemodynamic variables were affected.Conclusion: Fractional spinal anesthesia causes a low incidence of hypotension, induced mainly by a systemic venodilation, causing a decrease in venous return and fall in cardiac output. Our results show that fractional spinal anesthesia is a safe technique from a hemodynamic point of view and is probably underutilized in high-risk, elderly hip fracture patients

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Determination of the minimum initial intrathecal dose of isobaric 0.5% bupivacaine for the surgical repair of a proximal femoral fracture

Abstract: Clinicaltrials.gov identifier: NCT01680120.

Cited by 9 publications

References 15 publications

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

Fractional spinal anesthesia and systemic hemodynamics in frail elderly hip fracture patients

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