PROPHYLACTIC IM EPHEDRINE IN BUPIVACAINE SPINAL-ANESTHESIA

in a double-blind, placebo-controlled, randomized study, we have inves tigated the efficacy of i.m. ephedrine in 98 elderly patients undergoi ng hip arthroplasty under spinal anaesthesia with plain bupivacaine. F ifty patients received ephedrine 0.6 mg kg(-1) body weight, deep in th e paravertebral muscles immediately after injection of bupivacaine, an d 48 received an equal volume of saline. Patients in both groups were given the same volumes of fluid before anaesthesia. Systolic arterial pressure during the first 60 min after anaesthesia remained significan tly more stable in the ephedrine-treated group, and there was also a s ignificantly smaller number of patients in this group who had decrease s in pressure of more than 30% of pre-block levels, and fewer required rescue i.v. ephedrine. An increase in heart rate or systolic pressure of greater than or equal to 20% from baseline was found in two patien ts in the ephedrine group and in one patient in the placebo group. We conclude that ephedrine 0.6 mg kg(-1) body weight administered in the paravertebral muscles immediately after plain bupivacaine spinal anaes thesia is a simple and effective means of reducing the incidence of hy potensive episodes in the elderly patient.