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Paliwal N, Kokate MV, Deshpande NA, Khan IA. Spinal Anaesthesia Using Hypobaric Drugs: A Review of Current Evidence. Cureus 2024; 16:e56069. [PMID: 38618403 PMCID: PMC11009833 DOI: 10.7759/cureus.56069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2024] [Indexed: 04/16/2024] Open
Abstract
Spinal anesthesia is one of the most widely used techniques in modern anesthesia practice. It involves the injection of local anesthetic drugs into the cerebrospinal fluid (CSF) within the subarachnoid space. The choice of drug, its concentration, and baricity play a crucial role in determining the characteristics of the spinal block and has evolved over the years with continuous advancements in drug formulations and administration methods. Spinal anesthesia with hypobaric drugs represents a valuable technique in the armamentarium of anesthesiologists, offering distinct advantages in terms of targeted action, reduced systemic toxicity, and enhanced hemodynamic stability. This review aims to scan the characteristics of hypobaric drugs, factors influencing their spread within the spinal canal, challenges associated with their use, clinical applications in various surgical scenarios, and potential implications for patient outcomes and healthcare practice. PubMed and Google Scholar databases were searched for relevant articles and a total of 23 relevant articles were selected for the review based on inclusion and exclusion criteria. Hypobaric drugs have many advantages in high-risk morbidly ill patients for some select surgical procedures and daycare surgeries. The concentration and volume of hypobaric drugs need to be selected according to the extensiveness of the surgery and the desired block can be achieved by giving spinal injection in specific positions. The dynamic field of anesthesiology encompasses the integration of emerging technologies and evidence-based practices, which will contribute to further refining the safety and efficacy of spinal anesthesia with hypobaric drugs.
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Affiliation(s)
- Naresh Paliwal
- Anesthesiology, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, IND
| | - Minal V Kokate
- Anesthesiology, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, IND
| | - Nandini A Deshpande
- Anesthesiology, Dr. Panjabrao Deshmukh Memorial Medical College, Amravati, IND
| | - Imran Ahmed Khan
- Community Medicine, Baba Raghav Das Medical College, Gorakhpur, IND
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Liu S, Chen J, Shi H, Li J, Zeng G, Liu W, Hu W, Li S, Gao W, Song W, Liang A, Chen Y. Comparing perioperative outcomes between regional anesthesia and general anesthesia in patients undergoing hip fracture surgery: a systematic review and meta-analysis. Can J Anaesth 2024:10.1007/s12630-024-02696-3. [PMID: 38418761 DOI: 10.1007/s12630-024-02696-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 03/02/2024] Open
Abstract
PURPOSE Nearly all patients with hip fractures undergo surgical treatment. The use of different anesthesia techniques during surgery may influence the clinical outcomes. The optimal anesthetic technique for patients undergoing hip fracture surgery is still controversial. We performed this updated systematic review and meta-analysis to compare clinical outcomes of patients undergoing hip fracture surgery with different anesthesia techniques. SOURCE Articles published from 2000 to May 2023 were included from MEDLINE, Embase, Web of Science, and the Cochrane Library. We included randomized controlled trials and observational studies comparing general anesthesia (GA) with regional anesthesia (RA) for the outcomes of 30-day mortality, 90-day mortality, in-hospital mortality, perioperative complications, length of hospital stay, and length of surgery in patients undergoing hip fracture surgery. Subgroup analyses were performed for the outcomes based on study design (randomized controlled trials or observational studies). We used a random-effects model for all analyses. PRINCIPAL FINDINGS In this meta-analysis, we included 12 randomized controlled trials. There was no difference in postoperative 30-day mortality between the two groups (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.44 to 1.74; I2 = 0%). The incidence of intraoperative hypotension was lower in patients who received RA vs GA (OR, 0.52; 95% CI, 0.38 to 0.72; I2 = 0%). No significant differences were observed in 90-day mortality, in-hospital mortality, postoperative delirium, pneumonia, myocardial infarction, venous thromboembolism, length of surgery, and length of hospital stay. CONCLUSION In this updated systematic review and meta-analysis, RA did not reduce postoperative 30-day mortality in hip fracture surgery patients compared to GA. Fewer patients receiving RA had intraoperative hypotension than those receiving GA did. Apart from intraoperative hypotension, the data showed no differences in complications between the two anesthetic techniques. STUDY REGISTRATION PROSPERO (CRD42023411854); registered 7 April 2023.
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Affiliation(s)
- Song Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianan Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Huihong Shi
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jianhong Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Gang Zeng
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenzhou Liu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjun Hu
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shaoguang Li
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wenjie Gao
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weidong Song
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Anjing Liang
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yanbo Chen
- Department of Orthopedics, Sun Yat-Sen Memorial Hospital, Sun Yat-sen University, Yingfeng Road, 33th Haizhu District, Guangzhou, 510000, China.
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Reider L, Furgiuele D, Wan P, Schaffler B, Konda S. Anesthetic Methods for Hip Fracture. Curr Osteoporos Rep 2024; 22:96-104. [PMID: 38129371 DOI: 10.1007/s11914-023-00835-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/03/2023] [Indexed: 12/23/2023]
Abstract
PURPOSE OF REVIEW To review the benefits, risks, and contraindications of traditional and new anesthesia approaches for hip fracture surgery and describe what is known about the impact of these approaches on postoperative outcomes. RECENT FINDINGS This review describes general and spinal anesthesia, peripheral nerve block techniques used for pain management, and novel, local anesthesia approaches which may provide significant benefit compared with traditional approaches by minimizing high-risk induction time and decreasing respiratory suppression and short- and long-term cognitive effects. Hip fracture surgery places a large physiologic stress on an already frail patient, and anesthesia choice plays an important role in managing risk of perioperative morbidity. New local anesthesia techniques may decrease morbidity and mortality, particularly in higher-risk patients.
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Affiliation(s)
- Lisa Reider
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - David Furgiuele
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
| | - Philip Wan
- Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA
| | - Benjamin Schaffler
- Department of Orthopaedic Surgery, NYU Langone Health, New York University Langone Orthopaedic Hospital, 310 East 17Th Street, Suite 1402, New York, NY, 10003, USA
| | - Sanjit Konda
- Department of Orthopaedic Surgery, NYU Langone Health, New York University Langone Orthopaedic Hospital, 310 East 17Th Street, Suite 1402, New York, NY, 10003, USA.
- Department of Orthopaedic Surgery, Jamaica Hospital Medical Center, Queens, NY, USA.
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Lin H, Zhu Y, Ren C, Ma T, Li M, Li Z, Xu Y, Wang Q, Hu J, Zhang K. Comparing the Effect of Spinal and General Anesthesia for Hip Fracture Surgery in Older Patients: A Meta-analysis of Randomized Clinical Trials. Orthop Surg 2023; 15:3254-3262. [PMID: 37753546 PMCID: PMC10693995 DOI: 10.1111/os.13895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVE Hip fractures are the most common fractures among older adults, with most patients undergoing surgery. The debate regarding the type of anesthetic technique for hip fracture surgery is still ongoing. This meta-analysis aimed to compare the intraoperative and postoperative outcomes of spinal and general anesthesia in older patients undergoing hip fracture surgery. METHODS Eligible studies that compared the effects of spinal and general anesthesia were systematically searched from PubMed, Embase, and the Cochrane Library until May 27, 2022. The intraoperative and postoperative outcomes of the two anesthesia techniques were compared. Quality assessment, heterogeneity analysis, and publication bias of the studies were also assessed. RESULTS Nine articles of methodological quality were included in the meta-analysis. The pooled results revealed that there were significant differences in hypotension (risk ratio [RR] (95% confidence interval [CI]) = 0.81 (0.68, 0.97), p = 0.02) and ephedrine dose (weighted mean difference [WMD] [95%CI] = -20.94 [-37.50, -4.37] mg, p = 0.01) between the spinal and general anesthesia groups. However, no significant differences were observed in the use of ephedrine (RR [95% CI] = 0.77 [0.19, 3.05]), blood loss (WMD [95%CI] = -34.38 [-89.56, 20.80) mL], myocardial infarction (RR [95% CI] = 0.78 [0.31, 1.94] mL), heart failure (RR [95% CI] = 0.87 [0.17, 4.36] mL), stroke (RR [95%CI) = 0.65 [0.22, 1.95] mL), postoperative nausea and vomiting (RR [95% CI] = 0.88 [0.17, 4.35] mL), delirium (RR [95% CI] = 1.08 [0.89, 1.31] mL), and mortality (RR [95% CI] = 1.10 [0.72, 1.68] mL) (all p < 0.05). No publication bias was observed in any of the included studies. CONCLUSION Compared to general anesthesia, spinal anesthesia was associated with a lower risk of intraoperative hypotension and lower doses of ephedrine in older patients undergoing hip fracture surgery.
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Affiliation(s)
- Hua Lin
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Ying Zhu
- Department of Neurology, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Cheng Ren
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Teng Ma
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Ming Li
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Zhong Li
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Yibo Xu
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Qian Wang
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Jing Hu
- Department of Nursing, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
| | - Kun Zhang
- Department of Orthopedic Trauma, Honghui HospitalXi'an Jiaotong UniversityXi'anChina
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Nelson M, Pal N, Kertia MD. Less Blood Pressure But Not Less AKI. Anesth Analg 2023; 137:e13. [PMID: 37450912 DOI: 10.1213/ane.0000000000006527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Affiliation(s)
- Mark Nelson
- Department of Anesthesiology, Virginia Commonwealth University
| | - Nirvik Pal
- Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA,
| | - Miklos D Kertia
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
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Lopez-Lopez D, Neira-Somoza P, Carballo-Fernandez J, Mato-Bua R, Casas-Reza P. Physiological Remarks on Spinal Anesthesia, Drug Baricity, and Clinical Results. Anesth Analg 2023; 137:e3-e4. [PMID: 37326872 DOI: 10.1213/ane.0000000000006528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Affiliation(s)
- David Lopez-Lopez
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain,
| | - Patricia Neira-Somoza
- Surgical and Perianesthesia Nursery Department Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Jesus Carballo-Fernandez
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Rocio Mato-Bua
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Pablo Casas-Reza
- Department of Anesthesiology, Perioperative Care and Pain Medicine, Complexo Hospitalario Universitario de A Coruña, A Coruña, Spain
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Flanagan CD, Vallier HA. What's New in Orthopaedic Trauma. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00803. [PMID: 37192304 DOI: 10.2106/jbjs.23.00244] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Affiliation(s)
- Christopher D Flanagan
- Department of Orthopaedic Surgery, Orthopaedic Trauma Service, Florida Orthopaedic Institute, University of South Florida, Tampa, Florida
| | - Heather A Vallier
- Department of Orthopaedic Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio
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