A retrospective, observational, single-centre, cohort database analysis of the haemodynamic effects of low-dose spinal anaesthesia for hip fracture surgery
Authors' conclusion
Low doses of hyperbaric spinal 0.5% bupivacaine (1.3 ml, 6.5 mg) are associated with minimal reductions in blood pressure during surgery and provide adequate duration of surgical anaesthesia.
Study context
- Population
- Patients undergoing unilateral hip fracture surgery under spinal anaesthesia
- Participants
- 280 patients
- Exposure
- Low-dose spinal bupivacaine vs historical equivalents
- Hyperbaric spinal bupivacaine 0.5%n = 280
- Outcome
- Intraoperative MAP vs baseline (spinal injection) MAP
Methodological detailsobservational, single-centre, database analysis
- Observational
- Single-centre
- Database analysis
Main finding
As reported in the abstract
Mean cohort mean arterial pressure (MAP) within 10% of baseline MAP for 97/98 subsequent aggregated 1-min recording intervals
99.0%
Observational data: associations, not effects.
Further findings
Lowest MAP <70 mm Hg · significantly lower
<0.0001
Lowest MAP <55 mm Hg · significantly lower
<0.0001
Proportion of 10 551 MAP readings <70 mm Hg and <55 mm Hg
- MAP readings <70 mm Hg
- 6.7%
- MAP readings <55 mm Hg
- 0.4%
Relatively persistent hypotension (MAP ≤70 mm Hg for ≥5 intraoperative readings)
- Patients with persistent hypotension
- 45 (16.1%)
- Frail (Nottingham Hip Fracture Score ≥7/10), persistent hypotension vs normotensive: 37.8% vs 19.6%
- P = 0.0109
- Taking alpha-/beta-blockers, persistent hypotension vs normotensive: 44.4% vs 24.3%
- P = 0.0099
Duration of surgical anaesthesia
- Patients requiring supplemental local anaesthesia during skin closure
- 1
- Surgical anaesthesia effective for up to 190 min
Original publication
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