الفهرس 
THE GERIATRIC PATIENTOnly 14 pages are availabe for public view
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Abstract
Epidural anesthesia and analgesia have the potential to reduce or eliminate the perioperative physiologic stress responses to surgery and thereby decrease surgical complications and improve outcomes.
The aim of this study was to compare among the intraoperative, postoperative anesthetic and analgesic effects and safety of adding fentanyl, ketamine or midazolam to bupivacaine in epidural anesthesia in geriatric patients undergoing orthopedic surgery.
To achieve this target, 100 elderly patients indicated for lower limb orthopedic surgeries were included in the study. The patients were randomly allocated into one of 4 study groups, each group is 25 patients: (B group); which received 12 ml bupivacaine 0.5% in the epidural catheter followed by infusion rate of about 5-10 ml/h. according to pain score to be less than 40, (BF group) which received a mixture of bupivacaine 0.5 % 12 ml + fentanyl 50 ug; followed by infusion of 5-10 ml/h of the mixture according to pain score to be less than 40, (BK group) which received a mixture of bupivacaine 0.5 %; 12 ml + ketamine 30 mg; followed by infusion of 5-10 ml/h of the mixture according to pain score to be less than 40, or (BM group) which received a mixture of bupivacaine 0.5 %; 12ml + midazolam 0.05 mg/kg BW); followed by infusion of 5-10 ml/h of the mixture according pain score to be less than 40.
Statistical analysis of the reported patients’ ages in the studied groups revealed that no statistically significant differences were detected among groups.
Calculation of the body mass index in the studied groups showed no statistically significant differences among groups.
Sex distribution in the studied groups comprised 17 males (68.0 %) and 8 females revealed that no statistically significant differences were detected among groups regarding sex distribution.
In addition, comparison of the operative characteristics had shown that the performed operations in the studied groups revealed that no statistically significant differences in the operative duration among groups. Statistically, there was no significant difference among groups regarding the distribution of operative locations.
Furthermore, the baseline findings were shown to be statistically similar among groups.
Comparison of the motor and sensory blocks in the studied groups had shown that B group had significantly delayed onset of sensory and motor blocks that the other three groups.
As regards the hemodynamic parameters in terms of mean arterial blood pressure and heart rate, intergroup and intragroup comparisons in the current study revealed no statistically significant differences.
In respect to respiratory parameters as evaluated by respiratory rate and oxygen saturation, no statistically significant differences were detected whether by the intergroup or intra-groups comparisons.
Considering serum glucose as an indicator of surgical stress response, the present study didn’t not statistically significant differences among groups throughout the study assessment intervals. However, intragroup comparisons showed mild increase in the intraoperative serum glucose levels which was abolished postoperatively.
Regarding the postoperative analgesia in the studied groups, has declared that comparison of postoperative pain scores had revealed that B group had the worst pain score at 1 h. PO interval when compared with the other three groups with Statistically significant differences among groups throughout the study.
Retrograde analysis had revealed non-significant differences among BF, BK and BM groups at the different assessment intervals in spite of the fact that BF had better pain control followed by BK and BM.
Comparison of the time recorded to the first rescue analgesic dose had shown a significantly shorter time in B group when compared with the BF and BK groups Retrograde analysis had declared lack of statistical significance between B and BM, BF and BK, BF and BM and BK and BM groups.
Conclusion: for achieving postoperative analgesia many additives to epidural Bupivacaine had been suggested. These additives were proven to be better in achieving postoperative analgesia when given by the epidural route than when given intravenously. All epidural additives with the suggested doses in the study proved to be effective as adjuvant to bupivacaine in epidural anesthesia without significant adverse effects.
Recommendation: It is recommended to give different doses of epidural additives to Bupivacaine to choose the optimum required dose.