DefinePK

Abstract

Background: Elderly patients undergoing orthopedic procedures such as dynamic hip screw (DHS) fixation are particularly vulnerable to hemodynamic instability under spinal anesthesia due to reduced physiological reserves and impaired cardiovascular reflexes. Traditional intrathecal anesthetic techniques may lead to significant hypotension, highlighting the need for safer approaches. The addition of intrathecal opioids like fentanyl to low-dose local anesthetics may offer enhanced hemodynamic control without compromising analgesic efficacy.
Objective: To compare the hemodynamic effects of standard-dose intrathecal bupivacaine versus low-dose bupivacaine with fentanyl in elderly patients undergoing DHS surgery.
Methods: A randomized controlled trial was conducted at the Orthopedics and Spine Center of Ghurki Trust Teaching Hospital, Lahore, from December 1, 2024, to May 1, 2025. Seventy-four patients aged 65 years and above, ASA I–II, were enrolled and randomized into two groups of 37 each. Group A received 10 mg of 0.5% bupivacaine intrathecally, while Group B received 7.5 mg of 0.5% bupivacaine with 20 µg fentanyl. Systolic blood pressure (SBP) was recorded before spinal anesthesia and at 15-minute intervals for 60 minutes post-administration.
Results: Group A exhibited a marked drop in SBP with mean values declining from 136.2 ± 7.4 mmHg at baseline to 102.5 ± 6.9 mmHg at 60 minutes. In contrast, Group B maintained greater stability with SBP reducing from 134.1 ± 9.1 mmHg to 120.3 ± 8.7 mmHg. The difference in SBP decline between the two groups was statistically significant at all intervals (p < 0.05), indicating superior hemodynamic control in Group B.
Conclusion: The combination of low-dose bupivacaine with fentanyl offers a more stable and safer alternative to standard bupivacaine alone for elderly patients undergoing DHS surgery, significantly reducing hypotensive episodes while ensuring adequate anesthesia.
Keywords: Aged, Bupivacaine, Fentanyl, Hemodynamics, Hip Fractures, Hypotension, Spinal Anesthesia.