Comparison of hemodynamic effects of spinal anesthesia with hypobaric and hyperbaric bupivacaine in geriatric patients undergoing hip surgery

The aim of our study was to compare the hemodynamic effects of unilateral spinal anesthesia performed with hypobaric and hyperbaric bupivacaine in geriatric patients undergoing hip fracture surgery in the supine position. After obtaining approval from the ethics committee, a total of 70 patients over 65 years of age, classified as ASA I– III, were prospectively included in the study. Patients were randomly assigned to two groups: hypobaric (Hypo B) and hyperbaric (Hyper B) bupivacaine. Following premedication for analgesia, patients were positioned in the lateral decubitus position according to the baricity of the solution, and spinal anesthesia was administered with 9 mg of bupivacaine (in a 3 mL volume) intrathecally. After the intrathecal injection, patients were maintained in the lateral position for 15 minutes and then positioned supine for surgery. During the operation, systolic, diastolic, and mean arterial pressures, as well as heart rate, were recorded at regular intervals. Sensory block levels were evaluated using the pinprick test, and motor block was assessed using the Bromage scale. Demographic data, types of femoral fracture, and surgical procedures were comparable between the two groups. No significant differences were observed between groups regarding the incidence of hypotension, total ephedrine dose administered, or the requirement for norepinephrine infusion. Similarly, no differences were detected in the time to reach the T8 sensory block level or in the time to achieve complete motor block. In conclusion, spinal anesthesia performed with hypobaric and hyperbaric bupivacaine provides similar hemodynamic stability in geriatric patients undergoing hip surgery. Both formulations can be safely used for spinal anesthesia in this population.