Does Adding Lidocaine to Intrathecal Bupivacaine Affect Hemodynamic Parameters during Hip Fracture Surgery?

Document Type : RESEARCH PAPER

Authors

1 Anesthesiology Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran

2 Orthopedic Research Center, Poursina Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran

3 Guilan University of Medical Sciences (GUMS), Rasht, Iran

4 Anesthesiology Research Center, Alzahra Hospital, Guilan University of Medical Sciences (GUMS), Rasht, Iran

Abstract

Background: Hip fracture is one of the most common problems in elderly that needs surgical repair. As, the majority of
these patients have chronic diseases, they are at increased risk of peri-operative mortality and morbidity. The purpose
of this study was to evaluate spinal anesthesia with bupivacaine vs bupivacaine in combination with lidocaine in terms
of hemodynamic changes in patients undergoing hip fracture surgery.
Methods: This double-blind clinical trial was conducted on 292 patients undergoing surgery for hip fracture under
spinal anesthesia. Patients were allocated into two groups of B (10 mg of hyperbaric 0.5% Bupivacaine) and BL (5 mg
hyperbaric Bupivacaine 0.5% plus 50 mg Lidocaine 5%). Sensory and motor block and hemodynamic changes were
consecutively measured before spinal anesthesia (T0), immediately after spinal injection (T1), every 5 minutes for half
an hour (T2- T7), and at 45 minutes (T8) and 60 minutes (T9) after injection.
Results: Patients in the two groups were homogeneous in demographic characteristics including age, sex, BMI, ASA
Class, baseline blood pressure and heart rate. The onsets of sensory and motor blocks in group BL were faster than
group B (P=0.0001). Also, the durations of sensory and motor blocks in group B were significantly longer than group
BL (P=0.0001). The BL group had a significantly lower systolic blood pressure in all periods (P<0.05). Although the
heart rate in the BL group was lower than group B at all time points, this difference was only significant during T2-T3
(P=0.033 and P=0.0001, respectively). Group BL had significantly more episodes of hypotension, bradycardia, nausea
and vomiting (P=0.0001, P=0.023, P=0.003, and P=0.033, respectively).
Conclusion: According to our findings, using Lidocaine 50 mg in combination with Bupivacaine 5 mg, compared with
Bupivacaine 10 mg alone for spinal anesthesia in hip fracture fixation surgeries was associated with more hypotension
and bradycardia. As a result, combination of Bupivacaine with Lidocaine at this dose is not recommended for induction
of anesthesia in these patients.
Level of evidence: II

Keywords

Main Subjects

References

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The Archives of Bone and Joint Surgery
Volume 6, Issue 5
September 2018
Pages 390-396

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History

  • Receive Date: 12 August 2017
  • Revise Date: 23 November 2017
  • Accept Date: 28 November 2017

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