0.5% Bupivacaine in Spinal Anaesthesia in Geriatric Patients Undergoing Lower Limb Surgeries

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0.5% Bupivacaine in Spinal Anaesthesia in Geriatric Patients Undergoing Lower Limb Surgeries

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Why is it important?

Background: The geriatric population faces serious problems. When combined with the tendency for older population to have more unsteady balance and vision problems, it becomes a recipe for increased risk of fracture. Aims: Hemodynamic stability during perioperative period is of paramount importance in such scenario and hence the technique of choice becomes neuraxial block. The anesthetist’s traditional approach to provide anesthesia for geriatric population has been the emphasis on maintaining hemodynamic stability by maintaining heart rate, saturation, blood pressure and by avoiding hypotension, bradycardia etc. This study aimed to compare the efficacy of intrathecal 0.5% Bupivacaine and 0.5% Levobupivacaine in geriatric patients. Methods: After ethical committee permission, a comparative study was conducted in the department of Anesthesia at BLDE (DU’s) Shri BM Patil Medical College, Hospital and Research Center, Vijayapur. With prior informed written consent, study was conducted on total of 120 geriatric patients above 60 years of age with American society of anesthesiologist (ASA) Grade II–III scheduled for lower limb surgeries under spinal anesthesia. The patients either received 0.5 % hyperbaric Inj. Bupivacaine 3 ml (60 patients) Group B (Bupivacaine) or 0.5 % hyperbaric Inj. Levobupivacaine 3 ml (60 patients) Group L (Levobupivacaine) The time for onset of sensory block between the two groups was the primary endpoint. Other measurements included were time to Grade 4 motor blockade and time to 2 segment regression, Hemodynamic changes (RR, SpO2, MAP, HR), Time to rescue analgesia and side effects if any. Results: Statistical analysis was done using Chi-square test and Unpaired t-test. Time to onset of sensory blockade was significantly faster (p – value < 0.001) in Levobupivacaine Group compared to Bupivacaine Group. Also, there was a significant increase in heart rate, respiratory rate in patients of Group L with p < 0.001. Time to Grade 4 motor blockade, time to 2-segment regression and time to rescue analgesia were also increased in Group L patients with p = 0.872, p < 0.046 and p < 0.002 respectively. Mean arterial pressure was increased in Group B patients with p < 0.02. Side effects like hypotension was significantly less (p - value < 0.001) with Group Levobupivacaine compared to Group Bupivacaine. Conclusions: Increased incidence of intraoperative hypotension with Bupivacaine suggests that L evobupivacaine is a better drug in maintaining perioperative hemodynamics in a geriatric patient undergoing lower limb orthopedic surgery.

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