Efficacy of sequential intrathecal injection of Hyperbaric Bupivacaine-Fentanyl followed by Isobaric Bupivacaine compared with Hyperbaric Bupivacaine-Fentanyl in orthopaedic lower limb surgeries in geriatric patients: A prospective randomised double blind clinical study

The aim of this study is to compare the efficacy of sequential injection of hyperbaric bupivacaine with fentanyl followed by isobaric bupivacaine and hyperbaric bupivacaine with fentanyl intrathecally and to study the haemodynamic effects and recovery in lower limb surgeries in geriatric patients. 84 patients for lower limb orthopaedic surgeries will be randomly allocated in two different groups. In each group, there will be 42 patients who are posted for elective or emergency lower limb orthopaedic surgeries.In one group HIB group, Inj. Hyperbaric Bupivacaine 1 ml with Inj. Fentanyl 0.5ml followed by Inj. Isobaric Bupivacaine 1ml will be given intrathecally without barbotage. In second group, HB group, Inj. Hyperbaric Bupivacaine 2 ml with Inj. Fentanyl 0.5ml will be given intrathecally. As the primary outcome, haemodynamic stability (blood pressure, pulse rate) and number of doses of Inj. Ephedrine (5mg) i.v. required will be observed. As the secondary outcome, comparison of sensory and motor blockade characteristics will be assessed. The proposed advantage of this study is that the sequential intrathecal administration of Inj. Hyperbaric Bupivacaine+ Inj. Fentanyl followed by Inj. Isobaric Bupivacaine may be helpful in reduction of intraoperative hypotension and subsequent lower vasopressor requirements in geriatric patients while achieving satisfactory block characteristics (e.g., onset, intensity, and duration) when compared to Inj. Hyperbaric Bupivacaine+ Inj. Fentanyl alone.