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

Abstract

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