Prospective randomized study to assess the effect of intramuscular glycopyrrolate on hypotension prevention among elderly patients following subarachnoid block during lower limb surgeries.

Spinal anesthesia is a preferred technique for lower limb surgeries in elderly patients but often leads to hypotension due to sympathetic blockade and diminished cardiovascular adaptability. Glycopyrrolate, an anticholinergic agent, may mitigate this response by sustaining heart rate and venous return. Hence, this prospective randomized study evaluated 50 elderly patients (≥ 60 years) undergoing elective lower limb surgery under spinal anesthesia, divided into a glycopyrrolate group (0.2 mg IM given 30 minutes pre-block) and a control group without premedication. Hemodynamic parameters were recorded intraoperatively and compared between groups. The glycopyrrolate group showed significantly fewer cases of hypotension, better maintenance of mean arterial pressure and heart rate and a reduced need for vasopressors, without notable adverse effects such as tachycardia or dry mouth. Thus, we show that the pre-anesthetic intramuscular glycopyrrolate is a simple, safe and effective measure to enhance hemodynamic stability and prevent hypotension in elderly patients receiving spinal anesthesia.