Fractionated dose of hyperbaric bupivacaine for hemodynamic stability and prolonged duration of anaesthesia in high-risk geriatric patients undergoing unilateral hip surgeries under subarachnoid block- A case series

Abstract

Poor cardiopulmonary reserve, multiple comorbidities and polypharmacy in geriatric patients result in significant hemodynamic changes after the subarachnoid block (SAB) which are often unpredictable and requires administration of fluids, vasopressors, invasive monitoring and ICU admission leading to poor post operative outcome especially in patients belonging to American Society of Anaesthesiologists Physical Status (ASA PS) 3 & 4. Fractionated dose of hyperbaric bupivacaine for preferential unilateral lower limb blockade is found to have excellent hemodynamic stability and more duration of action making it a better alternative to the bolus dose in unilateral hip surgeries in high-risk geriatric patients. Here is a case series of 20 high risk geriatric patients who successfully underwent unilateral hip surgeries under fractionated dose of spinal anaesthesia with a stable perioperative hemodynamics.