Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial - Archive ouverte HAL Accéder directement au contenu
Article Dans Une Revue Anesthesia & Analgesia Année : 2022

Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial

Marine Simonin
  • Fonction : Auteur
Claire Delsuc
  • Fonction : Auteur
Pascal Meuret
  • Fonction : Auteur
Liana Caruso
  • Fonction : Auteur
Robert Deleat-Besson
  • Fonction : Auteur
Antoine Lamblin
  • Fonction : Auteur
Laetitia Huriaux
  • Fonction : Auteur
Paul Abraham
  • Fonction : Auteur
Cyril Bidon
  • Fonction : Auteur
Joris Giai
  • Fonction : Auteur
Thomas Rimmelé
  • Fonction : Auteur

Résumé

BACKGROUND: Hypotension during surgery is frequent in the elderly population and is associated with acute kidney and myocardial injury, which are, themselves, associated with increased 30-day mortality. The present study compared the hemodynamic effects of hypobaric unilateral spinal anesthesia (HUSA) to general anesthesia (GA) in patients ≥70 years of age undergoing hip fracture surgery. METHODS: We conducted a single-center, prospective, randomized study. In the HUSA group, patients were positioned with the operated hip above, and the hypobaric anesthetic solution was composed of 9 mg ropivacaine, 5 µg sufentanil, and 1 mL of sterile water. Anesthesia was adjusted for the GA group. Mean arterial pressure (MAP) was measured with a noninvasive blood pressure upper arm cuff every 3 minutes. Hypotension was treated with a bolus of ephedrine and then a continuous intravenous of norepinephrine to obtain a MAP ≥65 mm Hg. Primary outcome was the occurrence of severe hypotension, defined as a MAP <65 mm Hg for >12 consecutive minutes. RESULTS: A total of 154 patients were included. Severe hypotension was more frequent in the GA group compared to the HUSA group (odds ratio, 5.6; 95% confidence interval, 2.7–11.7; P < .001). There was no significant difference regarding the short-term outcomes between the HUSA and GA groups: acute kidney injury (respectively, 5.1% vs 11.3%; P = .22), myocardial injury (18.0% vs 14.0%; P = .63), and 30-day mortality (2.4% vs 4.7%; P = .65). CONCLUSIONS: HUSA leads to fewer episodes of severe intraoperative hypotension compared to GA in an elderly population undergoing hip fracture surgery.
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Dates et versions

hal-04385143 , version 1 (10-01-2024)

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Marine Simonin, Claire Delsuc, Pascal Meuret, Liana Caruso, Robert Deleat-Besson, et al.. Hypobaric Unilateral Spinal Anesthesia Versus General Anesthesia for Hip Fracture Surgery in the Elderly: A Randomized Controlled Trial. Anesthesia & Analgesia, 2022, 135 (6), pp.1262-1270. ⟨10.1213/ANE.0000000000006208⟩. ⟨hal-04385143⟩
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