Intrathecal bupivacaine in elderly patients for orthopaedic surgery: Hyperbaric versus isobaric with epinephrine or clonidine

ABSTRACT

The effect of hyperbaric bupivacaine on the level of spinal anaesthesia for bed ridden elderly patients is unpredictable and of limited duration as regard to the effects of vasoconstrictors on the duration of isobaric bupivacaine spinal anaesthesia. A prospective controlled study was conducted on 60 patients aged 60 year or more who were scheduled for spinal anaesthesia for orthopedic surgery. The subjects were randomly allocated into three groups. All patients received 15 mg bupivacaine solution in 4 ml in the horizontal position. Group I patients received hyperbaric bupivacaine plus 1 ml normal saline; Group II patients received plain bupivacaine plus 0.2 mg epinephrine; Group III patients received plain bupivacaine plus 0.15 mg clonidine. The segmental level of sensory loss was tested. No significant difference was observed between mean highest levels of sensory anaesthesia. The mean time to two-segment regression from the highest level was significantly longer in group II than in group I and III Mean time for regression to the L2 segment was also significantly longer in groups II and III than in group I. This time tended to increase more with bupivacaine plus epinephrine solution than with bupivacaine plus clonidine solution