Hemanth Kumar, Ganapathi P
Introduction: Geriatric patients with significant autonomic dysfunction are the ones who present for hip fracture surgeries, Hence we undertook our study which compares ultralow dose bupivacaine with fentanyl which causes minimal hemodynamic instability with conventional dose of bupivacaine. Opiods and local anaesthetics administered together intrathecally have potent synergistic analgesic effect. Aim: To compare ultra low dose bupivacaine with fentanyl and conventional dose of bupivacaine in ASA II and ASA III patients posted for hip surgeries in regards to 1. hemodynamic stability, use of vasopressors and perioperative morbidity. 2. Duration of motor and sensory block Methodology: After obtaining approval from the Institutional Ethical Committee, the study was conducted on 52 patients belonging to physical status ASA classes II and III, aged 60–90 years, scheduled to undergo hip surgeries under spinal anesthesia. Group A will receive 1mL of 0.5% bupivacaine(5mg) + 20 mcg fentanyl and group B will receive 2mL of 0.5% bupivacaine(10 mg). Results: The demographic data (age, weight, sex and ASA grading) were comparable and statistically non significant. Mann- Whitney test was used for statistical analysis. The time of onset of adequate level of sensory block(T10) was longer for group A (128.96 +/- 2.53 sec) than group B (95.57 +/- 2.41 sec) and was statistically significant. Duration of motor block was longer in group B (111.23 +/- 3.64 min) as compared to group A (88 +/- 3.77 min) and was statistically significant. Duration of sensory block for group B (147.5 +/- 3,46 min) was slightly more compared to group A (141.86 +/- 4.34) and was found to be statistically significant. Conclusion: The use of ultralow dose bupivacaine plus fentanyl for spinal anaesthesia for surgical repair of hip fractures in elderly patients provides successful anaesthesia and incurs a minimum of hypotension.
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