Comparison of two protocols using low doses of bupivacaine for spinal anaesthesia during joint replacement in elderly patients

Diana Fernández-Galinski, Carmen Pulido, Jordi Real, Anna Rodríguez, Margarita M. Puig

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    Abstract

    Background and objectives: In elderly patients undergoing total joint arthroplasty, we evaluated the characteristics of the spinal block and incidence of adverse effects induced by the combination of low doses of bupivacaine, fentanyl and clonidine. The consequences of spinal anaesthesia on cognitive function in the immediate postoperative period were also assessed. Methods: In a double blind randomised study, we evaluated 61 patients aged 70-88 years undergoing hip or knee replacement under spinal anaesthesia. We compared the characteristics of the spinal block induced by 4 mg bupivacaine plus 15 μg each fentanyl and clonidine (group BFC), with those induced by 6.25 mg bupivacaine plus 25 μg fentanyl (group BF). Cognitive status and a previous history of hypertension were assessed. Results: Groups were comparable regarding demographic data, sensory/motor block, and requirements of epidural anaesthesia. No significant differences between groups were observed regarding the global incidence of adverse events; however, nausea and vomiting were absent in the BFC group. Hypotension in patients with pre-operative hypertension was observed in 63% and 32% in BF and BFC, respectively. In the recovery room, pain intensity at rest, during movement as well as patient controlled epidural analgesia requirements, were significantly lower in BFC patients (p = 0.041). Cognitive impairment was present in 16.4% of the patients in the immediate postoperative period, which was unrelated to the administration of benzodiazepines or the incidence of adverse effects. Conclusions: In elderly patients, the spinal block induced by 4 mg bupivacaine plus 15 μ-g each of fentanyl and clonidine provides adequate spinal anaesthesia and good postoperative analgesia, but does not significantly change the incidence of adverse effects. © 2005 VSP.
    Original languageEnglish
    Pages (from-to)15-24
    JournalPain Clinic
    Volume17
    Issue number1
    DOIs
    Publication statusPublished - 27 Apr 2005

    Keywords

    • Bupivacaine
    • Cognitive impairment
    • Elderly patients
    • Spinal anaesthesia

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