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Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension During Early Mobilization After Hip Arthroplasty: A Randomized, Double-blind, Placebo-controlled Trial

Oral Midodrine Hydrochloride for Prevention of Orthostatic Hypotension During Early Mobilization After Hip Arthroplasty: A Randomized, Double-blind, Placebo-controlled Trial

Øivind Jans, Jesper Mehlsen, Per Kjærsgaard-Andersen, Henrik Husted, Søren Solgaard, Jakob Josiassen, Troels Haxholdt Lunn, Henrik Kehlet

Anesthesiology. 2015 Dec;123(6):1292-300.

PMID: 26492477

Abstract:

Background:
Early postoperative mobilization is essential for rapid recovery but may be impaired by orthostatic intolerance (OI) and orthostatic hypotension (OH), which are highly prevalent after major surgery. Pathogenic mechanisms include an insufficient postoperative vasopressor response. The oral α-1 agonist midodrine hydrochloride increases vascular resistance, and the authors hypothesized that midodrine would reduce the prevalence of OH during mobilization 6 h after total hip arthroplasty relative to placebo.
Methods:
This double-blind, randomized trial allocated 120 patients 18 yr or older and scheduled for total hip arthroplasty under spinal anesthesia to either 5 mg midodrine hydrochloride or placebo orally 1 h before mobilization at 6 and 24 h postoperatively. The primary outcome was the prevalence of OH (decrease in systolic or diastolic arterial pressures of > 20 or 10 mmHg, respectively) during mobilization 6 h after surgery. Secondary outcomes were OI and hemodynamic responses to mobilization at 6 and 24 h.
Results:
At 6 h, 14 (25%; 95% CI, 14 to 38%) versus 23 (39.7%; 95% CI, 27 to 53%) patients had OH in the midodrine and placebo group, respectively, relative risk 0.63 (0.36 to 1.10; P = 0.095), whereas OI was present in 15 (25.0%; 15 to 38%) versus 22 (37.3%; 25 to 51%) patients, relative risk 0.68 (0.39 to 1.18; P = 0.165). At 24 h, OI and OH prevalence did not differ between groups.
Conclusions:
Preemptive use of oral 5 mg midodrine did not significantly reduce the prevalence of OH during early postoperative mobilization compared with placebo. However, further studies on dose and timing are warranted since midodrine is effective in chronic OH conditions.

Chemicals Related in the Paper:

Catalog Number	Product Name	Structure	CAS Number	Price
AP3092179	Midodrine hydrochloride		3092-17-9	Price

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