Clinical Observation Of Low-dose Hypobaric Bupivacaine With Combined Spinal-epidural Anaesthesia In Elderly Patients Undergoing Hip Arthroplasty

Objective:To observe the clinical effect and safety in elderly patients for hip arthroplasty performed using low-dose hypobaric bupivacaine with combined spinal-epidural anesthesia.Methods:Chose ASA Ⅱ~Ⅲ,age 70~90 years old,weight 45~80 kg,60 cases with combined spinal-epidural anesthesia for elective hip arthroplasty,divided into two groups(group Q and group D).The local anesthetic solution was prepared as follows: Group Q,0.7 ml(5.25 mg)of bupivacaine(0.75%)diluted with 2.3 ml of distilled water,administering 3.0 ml of this solution.Group Q,0.7 ml(5.25 mg)of plain bupivacaine(0.75%).With the operating table in horizontal position,the patients were placed in lateral decubitus with the operated hip up,kept the patient in lateral position until the end of the surgery.Combined spinal-epidural anesthesia was carried out at L2/3 vertebral interspace in the lateral position.After free flow of cerebrospinal fluid was observed,the local anesthetic solution was injected toward the operated hip over 1min.Observe the analgesic onset time,the maximum blockage dermatome level and time,the time to reach T10 dermatome level,Bromage score,muscle relaxant score,mean arterial presure(MAP),heart rate(HR),cardiac output(CO),stroke volume(SV)changed after treatment,and the incidence of adverse reactions.Results:1.There were significant differences of the anesthesia onset time、the time to reach T10 、block level highest pain and time between the two groups(P﹤0.05).2.There were significant differences of unilateral subarachnoid block incidence between the two groups(P﹤0.05).3.Comparison of hemodynamics: comparison between the groups,there were statistically significant differences in the patients’ MAP at T1、T2、T3、T4,HR at T2、T3、T4,CO at T2、T3 and SV at T2、T3 between two groups(P﹤0.05).Comparison of the group: in group D,there were statistically significant differences in the patients’ MAP、HR、CO and SV at T1、T2、T3、T4 compared with these at T0(P﹤0.05)4.There were significant difference of hypotension 、the times of using vasoactive drugs and epidural anesthesia drugs intraoperatively between two groups(P﹤0.05).Conclusions:Low-dose hypobaric bupivacaine for combined spinal-epidural anesthesia could be safely and effectively used in elderly patients undergoing hip arthroplasty,easier to form unilateral subarachnoid block,favored the intraoperative hemodynamic stability.Therefore,low-dose hypobaric bupivacaine for combined spinal-epidural anesthesia used in elderly patients undergoing hip arthroplasty might be superior to isobaric bupivacaine.