Anaesthetic and Hemodynamic Effects of Continuous Spinal Anaesthesia Versus Single Dose Spinal Anaesthesia in Elderly Patients

Abstract

Forty patients (>70 years old) scheduled for retropubic transvesical prostatectomy were prospectively evaluated in order to compare quality of anaesthesia, complications and hemodynamic tolerance of titrated doses of plain bupivacaine using continuous spinal anaesthesia versus single dose spinal anaesthesia. Patients were randomized into two groups (Group K: continuous spinal anaesthesia, n: 20, Group S: single dose spinal anaesthesia, n: 20). The group S patients received 3 mL of 0.5% plain bupivacaine, and the group K patients received a starting dose of 1.5 mL of 0.5% plain bupivacaine, followed after 10 min by optional reinjection of 0.5 mL every 5 min until T10 level sensory block was reached. Onset of anaesthesia, hemodynamic variables, the need for ephedrine and complications were registered. Spinal anaesthesia was successful in all patients of both groups. Decreases in mean arterial pressure were significantly less pronounced in the group K than in the group S. The variations in heart rate were small and there was no significant difference between the two groups. The mean dose of ephedrine was significantly less in the group K than in the group S. No neurological complications related to the spinal anaesthesia technique were observed in either group. As a result of this study, the continuous spinal anaesthesia, using small titrated doses of 0.5% plain bupivacaine, is safe, efficient, and provides better hemodynamic stability than single dose spinal anaesthesia in elderly patients.