Comparison of Colloid versus Crystalloid Co-Loading to Prevent Hypotension in Patients Undergoing Hip or Femoral Fracture Surgery under Spinal Anesthesia: A Randomized Controlled Trial

Background: The incidence of hypotension in patients who undergo hip-fracture surgery is high and related to numerous complications. Objective: To compare colloid and crystalloid during spinal anesthesia in terms of their ability to prevent intraoperative hypotension in patients who undergo hip or femoral fracture surgery. Materials and Methods: The present study was a prospective, randomized, single-blind, controlled trial approved by the Human Research Ethics Committee of the Faculty of Medicine, Prince of Songkla University. Sixty-eight patients who underwent hip or femoral fracture surgery under spinal anesthesia were recruited. The patients were randomized into the hydroxyethyl starch (Voluven®) group V and crystalloid fluid administration as lactated or acetated Ringer’s solution, group C. After spinal anesthesia, the patients received 500 mL of one of these fluids over 25 minutes as co-load. Results: Patient characteristics were similar in both groups. The incidence of hypotension was lower in group V than in group C at 28.9% in group V and 46.7% in group C. However, the difference was not statistically significant (p=0.211). Acute kidney injury did not occur in either group on postoperative day 1. Vasopressor requirement was not different between the groups with ephedrine (p=0.339) and norepinephrine (p=0.666) within one hour after spinal anesthesia. Conclusion: Co-loading with colloids did not yield a significantly lower incidence of hypotension after spinal anesthesia in hip or femoral fracture surgery.