Bupivacaine vs. Pethidine in Spinal Anesthesia of Old Patients: Haemodynamic Changes and Complications

Javad Aminisaman ； Hamzeh Hasani

《Asian Journal of Anesthesiology》 預刊文章 Pp. 1-9

https://doi.org/10.6859/aja.201907/PP.0001

摘要

Objective: Organ changes during the aging are one of the significant events in old patients. Orthopedic surgeries are common operations in these patients that accompany with hemodynamic changes as blood pressure decrease, heart rate, and respiratory rate change. On the other hand, pain management of the ancient patients due to negative consequences as tachycardia, blood pressure increase, and myocardial ischemia is vital. Various types of opioid analgesics have been used in order to pain control in these patients. We decided to conduct the present study in order to compare the hemodynamic changes of the old patients who undergo lower limbs orthopedic surgeries by applying subarachnoid bupivacaine and meperidine (pethidine). Methods: Sixty-six patients older than 60 years included according to inclusion and exclusion criteria and randomly allocated into two same groups, Then in the first group in the sitting posture by Quincke spinal needle 24 gauge, 12.5 mg of bupivacaine 0.5% (2.5 mL) injected in the subarachnoid space between L_2- L_3 or L_3-L_4. In the second group, in a same posture by applying the same spinal needle 24 gauge, 1 mg/ kg of preservative-free pethidine injected in the subarachnoid space between L_2-L_3 or L_3-L_4. The patients evaluated for duration of anesthesia and analgesia, hemodynamic changes and complications such as headache, pruritus, shivering, urinary retention, and respiratory depression.. Results: Thirty-two patients were males (48.5%) and 34 females (51.5%). There was no statistically significant difference between groups in surgery types (p = 0.063). The duration of anesthesia was not different (p = 0.268) but the duration of analgesia was significantly longer in pethidine group (p = 0.000). No statistically significant difference observed in any time of first 15 min up to 180 min following intervention in heart rate (p = 0.867). No statistical significant difference observed in blood pressure change between two groups (p = 0.605). The experience of headache was more common in the group of bupivacaine during and after the operation (p = 0.004 and 0.000, respectively). The need for pruritus treatment was more in the pethidine group (p = 0.016). However, the frequency of shivering during the operation was not significant (p = 0.202), but after surgery was signifi cantly commoner in bupivacaine group (p = 0.001), but urinary retention and respiratory depression occurrence were not significant (p = 0.228 and 0.720, respectively). Conclusion: By regarding different aspects of opioids use, it seems pethidine is more efficient due to longer analgesic time, similar hemodynamic changes, fewer headache, and shivering occurrence in comparison to bupivacaine in old patients.

關鍵字

bupivacaine ； hemodynamic change ； meperidine ； orthopedic surgery