Changes In Blood Pressure During Cemented Hemiarthroplasty For Hip Fracture In Elderly Patients Under Spinal Anaesthesia

Blood pressure changes around cement insertion during total hip arthroplasty have been investigated; however, there is little agreement regarding whether a similar phenomenon occurs during hemiarthroplasty in the elderly under spinal anaesthesia. Therefore, our objective was to examine blood pressure around cement insertion during hemiarthroplasty in the elderly. For this retrospective, single-centre, case series study, we identified 430 hips of patients aged >65 years who underwent cemented hemiarthroplasty under spinal anaesthesia from January 2010 to August 2018. The maximum regulation ratio (MRR) was used to express changes in blood pressure immediately after cement insertion and was calculated as follows: the greatest difference (positive or negative) during 5 min after cement insertion into the bone canal divided by systolic blood pressure just before cement insertion. The timings of vasopressor administration and blood transfusion were recorded. The median MRR was compared for each American Society of Anesthesiologists (ASA) classification. The mean MRR was 4.0% (SD:10.4; range -26 to 83). MRR of patients with a >10% increase in blood pressure was significantly less than that of patients with a <10% change in blood pressure. Vasopressor was used in three patients 10 min after cement insertion into the bone canal. There was no significant difference between MRR groups and ASA classification (p = 0.182, respectively). MRR was not significantly different for each ASA classification. However, few cases showed a reduction in blood pressure immediately after cement insertion, regardless of ASA classification.