การศึกษาเปรียบเทียบภาวะความดันเลือดต่ำหลังการระงับความรู้สึกด้วยวิธีฉีดยาชาเข้าช่องน้ำไขสันหลังเมื่อลดขนาดยาชา และเสริมฤทธิ์ด้วยเฟนตานิล (Fentanyl) เทียบกับขนาดยาชาปกติในผู้ป่วยสูงอายุที่เข้ารับการผ่าตัดยึดตรึงกระดูกข้อสะโพกหักด้วยแท่งเหล็ก ในโรงพยาบาลอุทัยธานี

Chonnikan  Aksornmee; Jongrak  Khanwilai; Nuanwan  Luangdaeng; Chalatda Jeammarang

Authors

Chonnikan Aksornmee Uthai Thani Hospital
Jongrak Khanwilai Uthai Thani Hospital
Nuanwan Luangdaeng Uthai Thani Hospital
Chalatda Jeammarang Uthai Thani Hospital

Keywords:

preoperative blood preparation, caesarean section, blood utilization indices

Abstract

Objective: To study the incidence of hypotension after spinal anesthesia with reduced doses of anesthetic combined with fentanyl compared to standard doses of anesthetic in elderly patients undergoing hip fracture fixation surgery at Uthai Thani Hospital.

Material and methods: This was a randomized, double-blind, controlled trial involving 50 participants divided into two groups. The control group received 0.5% hyperbaric bupivacaine 10 mg, while the study group received 0.5% hyperbaric bupivacaine 5 mg plus fentanyl 25 micrograms. The study aimed to compare the incidence of hypotension, ephedrine usage, fluid volumes, muscle weakness, pain scores, and postoperative morphine consumption within 24 hours.

Results: The incidence of hypotension during surgery significantly differed between the two groups (20% vs. 76%, respectively). The amount of ephedrine used was significantly different (1.3±3.8 vs. 12.1±11.1 in milligrams) and fluid administration (430 ±127.4 vs. 688 ±265.4 in milliliter). However, there were no significant differences in sensory and motor blockade, pain scores, or intravenous morphine use within 24 hours post-surgery.

Conclusion: Spinal anesthesia with reduced doses of anesthetic combined with fentanyl effectively prevents hypotension and reduces the need for vasopressors and fluid administration. However, there were no significant differences in sensory and motor blockade, pain scores, or intravenous morphine use within 24 hours post-surgery.

Keywords: Spinal Hypotension, Elderly, Hip fracture surgery.

References

Zewdie K, Genetu A, Mekonnen Y, Worku T, Sahlu A, Gulilalt D. Efficiency of blood utilization in elective surgical patients. BMC Health Serv Res 2019;19(1):804.

Woodrum CL, Wisniewski M, Triulzi DJ, Waters JH, Alarcon LH, Yazer MH. The effects of a data driven maximum surgical blood ordering schedule on preoperative blood ordering practices. Hematology 2017;22(9):571-577.

Haghpanah S, Miladi S, Kasraian L, Zamani A, Gholami M. Blood Transfusion Practice in Operating Rooms in Nemazee Hospital in Southern Iran. Arch Iran Med 2021;24(2):107-112.

Thabah R, Sailo LT, Bardoloi J, Lanleila M, Lyngdoh NM, Yunus M, Bhattacharyya P. Maximum surgical blood order schedule in a newly set-up tertiary care hospital. Anaesthesia, Pain and Intensive Care 2013;17:28-32.

Guduri PR, Shastry S, Raturi M, Shenoy A. Surgical blood ordering schedule for better inventory management: An experience from a tertiary care transfusion center. Med J Armed Forces India 2022;78:283-290.

Tiloklurs M, Klunklin G, Yimsabai J. Reduction the cost of blood preparation for transfusion in surgical patients by type and screen. Buddhachinraj Med J 2007;24:49-51.

พิมล เชี่ยวศิลป์,บรรณาธิการ. The Appropriate Use of Blood and Blood Components. พิมพ์ครั้งที่2. กรุงเทพมหานคร: สำนักพิมพ์ พิมพ์ณภัช; 2566.

Supakij Suwanrattanadech. Effectiveness index of routine crossmatch for elective caesarean section. Thai journal of anesthesiology 2020;46:149-53.

Ngamchuen Sripunlom, Sarwinee Ratchanon, Sirisuk Ouitrakul. Appropriateness of Routine Crossmatch in elective caesarean section for low risk postpartum hemorrhage pregnancies. Clinics in mother and child health 2018;15:1.

Trakulkasamsiri S. Cost reduction of crossmatching by type and screen protocol in Obstetrics patients at Queen Savang Vad-hana Memorial Hospital, Thai Red Cross Society. Bull Chiang Mai Assoc Med Sci 2007;40:114-117.

Chanachaisuwan P. Utilization in elective surgery at Police general hospital. Hematol Transfus Med J 2010;20:93-104.

Wilaiporn Chusri. An Approach to Blood Utilization in Elective Surgery at BMA General Hospital. J Hematol Transfus Med 2018;28:17-23.

Suwicha Limkitcharenporn. Blood Utilization and Influencing Factors of Postoperative Blood Transfusion for Patients Underwent Total Knee Arthroplasty in Damnoensaduak Hospital. Reg 4-5 Med J 2018 ;37:98-107

Iqbal K, Iqbal A, Rathore SS, Ahmed J, Ali SA, Farid E, Hasanain M, Azeem Q, Qadar LT, Memon FR, Azim D. Risk factors for blood transfusion in Cesarean section: A systematic review and meta-analysis. Transfus Clin Biol 2022;29:3-10.

OR Eyelade, OA Adesina, et al. Blood transfusion requirement during caesarean delivery: risk factors. Ann Ib Postgrad Med 2015;13:29-35.

Akinlusi FM, Rabiu KA, Durojaiye IA, Adewunmi AA, Ottun TA, Oshodi YA. Caesarean delivery-related blood transfusion: correlates in a tertiary hospital in Southwest Nigeria. BMC Pregnancy Childbirth 2018;18(1):24.