PROPHYLACTIC INTRAMUSCULAR EPHEDRINE REDU CES THE INCIDENCE OF HYPOTENSION AFTER SUBARACHNOID BLOCK IN THE ELDERLY

Objective: To assess the efficacy of intramuscular ephedrine for preve ntion of hypotension following subarachnoid block (SE) in the elderly. Study design: Prospective, randomized double blind study vs placebo. Patients: Twenty patients, aged 60 years or more, of physical class AS A 2 or 3, scheduled for surgical fixation of fractured neck of femur u nder SE, allocated into two groups of ten each. Methods: After oral pr emedication with hydroxyzine 50 mg, 90 min before surgery, and preload ing with cristalloid solution 10 mL.kg(-1), the subarachnoid space was punctured with the patient in lateral position using a 22 Gauge spina l needle at the L3-L4 or L4-L5 interspace. Patients were given 0.5% hy perbaric bupivacaine intrathecally, according to body weight. Patients in ephedrine group received intramuscular ephedrine 30 mg immediately after SE. Patients in placebo group received 1 mL of intramuscular sa line immediately after SE. When blood pressure decreased below 100 mmH g repeated bolus of ephedrine 6 mg were given intravenously. Results: Patients in both groups experienced a significant decrease in systolic pressure after SE, the decrease being significantly greater in the pl acebo group. Conclusion: Prophylactic intramuscular ephedrine is effec tive to prevent hypotension associated with SE in the elderly.