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Anesthesia in elderly patients undergoing orthopedic surgery for hip fractures

Bupivacaine (B) and levobupivacaine (LB) are medicines used regularly in spinal anesthesia. Whether potential differences in their hemodynamic and anesthetic profiles could determine a differential risk of complications in elderly subjects, is controversial.

The cognitive function in elderly patients during hospitalization has been, attributed to sudden changes in the usual environment of the patient along with the acute morbidity or exacerbation of pre-existing conditions. Geriatric patients suffering from hip fractures who undergo surgery are an especially frail population, because of concomitant morbidity, polypharmacy, and bleeding. A multi-factorial intervention aimed to preserve cognitive function in this population during the acute hospital stay has shown good results.

The anesthesia applied would be part of this multi-factorial intervention, although the evidence on the differential effects of spinal and general anesthesia on cognition is controversial. Short length hospitalization, could result in fewer complications, has been described for regional anesthesia, but it does not reduce mortality.

Both B and LB are used interchangeably for spinal anesthesia in hospitals all around the globe and the working hypothesis was that cerebral desaturation would be higher in patients treated with B than in those receiving LB and that this could be related to worse neurological outcomes. In order to test the hypothesis, researchers designed a pragmatic randomized clinical trial to compare the effect of B and LB on regional cerebral oxygen saturation, during spinal anesthesia in elderly patients undergoing surgery for hip fracture repair, both administered by a spinal route and according to routine clinical practice. They also compared the effects of both anesthetics on postoperative cognitive status and incidence of the nervous system related adverse events.

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