Comparison of Low-Dose Versus Standard-Dose Hyperbaric Bupivacaine in Spinal Anesthesia

Comparison of Low-Dose Versus Standard-Dose Hyperbaric Bupivacaine in Spinal Anesthesia: Hemodynamic Stability and Recovery Profile in Elderly Patients Undergoing Lower Limb Orthopedic Surgery

The goal of this randomized controlled trial is to determine whether low-dose hyperbaric bupivacaine provides better hemodynamic stability and postoperative recovery compared with standard-dose hyperbaric bupivacaine in elderly patients undergoing lower limb orthopedic surgery under spinal anesthesia.

The main questions it aims to answer are:

• Does low-dose hyperbaric bupivacaine reduce the incidence of intraoperative hypotension and bradycardia compared with standard-dose hyperbaric bupivacaine?
• Does low-dose hyperbaric bupivacaine improve postoperative recovery profile compared with standard-dose hyperbaric bupivacaine?

Researchers will compare elderly patients receiving low-dose hyperbaric bupivacaine with those receiving standard-dose hyperbaric bupivacaine to determine whether a lower intrathecal dose improves cardiovascular stability and recovery without compromising the effectiveness of spinal anesthesia.

Participants will:

• Provide written informed consent before enrollment.
• Undergo elective lower limb orthopedic surgery under spinal anesthesia.
• Be randomly assigned to receive either low-dose or standard-dose hyperbaric bupivacaine.
• Have their blood pressure, heart rate, and other vital signs monitored throughout the surgical procedure.
• Be assessed for intraoperative hypotension and bradycardia according to predefined study criteria.
• Be evaluated for postoperative recovery parameters, including motor recovery and readiness for postoperative recovery and mobilization.

The information obtained from this study may help identify a safer and more effective spinal anesthetic technique for elderly patients undergoing orthopedic surgery.

Inclusion Criteria:

• Male or female patients aged 65 years and above.
• Patients scheduled for elective lower limb orthopedic surgery under spinal anesthesia.
• American Society of Anesthesiologists (ASA) physical status I-III.
• Patients willing to participate and provide written informed consent.

Exclusion Criteria:

• Refusal to participate in the study.
• Contraindications to spinal anesthesia (e.g., infection at puncture site, coagulopathy, severe hypovolemia, raised intracranial pressure).
• Known hypersensitivity or allergy to bupivacaine.
• Severe valvular heart disease.
• Significant cardiac arrhythmias.
• Uncontrolled hypertension.
• Severe hepatic or renal impairment.
• Pre-existing neurological disorders affecting lower limb motor or sensory function.
• Severe spinal deformity or previous lumbar spine surgery interfering with spinal anesthesia.
• Cognitive impairment or inability to provide informed consent.
• Emergency orthopedic procedures.