Hypotension duration and vasopressor requirements following intrathecal oxytocin for Total hip arthroplasty: Secondary analysis of a randomized controlled trial.

Autor: Henshaw DS; Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States of America. Electronic address: dhenshaw@wakehealth.edu., Khanna AK; Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States of America., Edwards CJ; Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States of America., Eisenach JC; Department of Anesthesiology, Wake Forest School of Medicine, Winston Salem, NC, United States of America.
Jazyk: angličtina
Zdroj: Journal of clinical anesthesia [J Clin Anesth] 2023 Oct; Vol. 89, pp. 111189. Date of Electronic Publication: 2023 Jun 23.
DOI: 10.1016/j.jclinane.2023.111189
Abstrakt: Introduction: A recent publication investigating intrathecal oxytocin, 100 μg, administered immediately prior to a spinal anesthetic in patients undergoing primary total hip arthroplasty surgery demonstrated a reduction in disability for 3-weeks, increased walking distance at 8-weeks, and earlier opioid cessation. This secondary analysis study was undertaken to assess the acute cardiovascular safety and analgesic efficacy of intrathecal oxytocin in this study population.
Methods: 90 patients were included in the analysis (44 randomized to spinal oxytocin and 46 to placebo [saline]). Data collected prospectively during the previously published study were supplemented with additional retrospectively collected data. The primary outcomes were comparisons of the duration of hypotension (minutes with mean arterial pressure < 65 mmHg) and cumulative vasopressor requirements during the initial 60 min following spinal placement. Secondary outcomes included hypotension durations and vasopressor requirements at later time points, perioperative fluid administration, physical therapy metrics, time to first opioid administration, cumulative opioid consumption through 24 h, and verbal pain scores through 24 h.
Results: The duration of hypotension during the first 60 min following spinal placement did not differ between intrathecal oxytocin and placebo groups (12.2 ± 10.7 vs 14.0 ± 13.0 min, respectively; p = 0.476). There was also no difference in cumulative vasopressor requirements (1303 ± 883 vs 1156 ± 818 μg [phenylephrine equivalents]; p = 0.413) during that time period. No group differences were found for any of the investigated secondary outcomes.
Conclusion: The administration of 100 μg of intrathecal oxytocin does not significantly impact the duration of hypotension or the need for vasopressor agents when given as a component of a spinal anesthetic. The oxytocin and placebo groups also did not differ in regards to physical therapy related metrics, time to first opioid administration, cumulative opioids at 24-h, or pain scores through 24-h. What is already known on this topic: Rapid intravenous oxytocin causes hypotension after cesarean delivery, but intrathecal oxytocin does not cause hypotension in healthy volunteers.
What This Study Adds: Compared to saline control, intrathecal oxytocin, 100 μg did not increase the duration of hypotension or vasopressor requirements in patients during total hip arthroplasty. How this study might affect research, practice, or policy: Lack of hypotension from intrathecal oxytocin in this study supports future investigations to further explore its potential benefits, in terms of both analgesia and functional recovery following surgery.
Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: James Eisenach reports financial support was provided by National Institutes of Health.
(Copyright © 2023. Published by Elsevier Inc.)
Databáze: MEDLINE
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