Epidural will be given as anesthesia in a patient of ot internal fixation of trochanteric fracture by PFN .. which saline will be given ?
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The question is specifically about which IV saline (fluid preloading/co-loading) is given to a patient receiving epidural anesthesia for orthopedic surgery — not about the loss-of-resistance technique. This is a well-established clinical principle I can answer directly.
Fluid Management with Epidural Anesthesia for PFN Fixation
The saline given is Normal Saline (0.9% NaCl) or Ringer's Lactate (preferred) as an IV fluid preload / co-load, given to prevent the sympathetic blockade-induced hypotension that accompanies epidural anesthesia.
Why is IV fluid given?
Epidural anesthesia causes a sympathetic block → peripheral vasodilation → decreased venous return → hypotension. To counteract this, IV fluid is administered before or alongside induction.
Which fluid?
| Fluid | Use |
|---|---|
| Ringer's Lactate (RL) | Most commonly used preload/co-load — isotonic, balanced crystalloid, preferred in orthopedic cases |
| Normal Saline (0.9% NaCl) | Also used; risk of hyperchloremic acidosis with large volumes |
| Colloids (e.g., Hetastarch) | More effective volume expanders but rarely used first-line |
Ringer's Lactate is the standard of care for preloading before neuraxial (spinal/epidural) anesthesia in most orthopedic surgeries, including trochanteric fracture fixation with PFN.
Standard Preload Protocol
- 500–1000 mL of Ringer's Lactate IV infused rapidly before or during epidural induction
- This helps maintain blood pressure and cardiac output during the sympathetic block
Additional Notes for Trochanteric Fracture / PFN
- These patients are often elderly with limited cardiac reserve — fluid should be given cautiously to avoid overload
- Epidural is preferred over general anesthesia in these patients to reduce blood loss, DVT risk, and postoperative cognitive dysfunction
- Vasopressors (ephedrine, phenylephrine) should also be available as backup for refractory hypotension
In summary: Ringer's Lactate (RL) is the standard saline given as IV preload before epidural anesthesia for internal fixation of trochanteric fractures with PFN. Normal saline is an acceptable alternative when RL is unavailable.
— Barash, Cullen, and Stoelting's Clinical Anesthesia, 9e (Epidural Anesthesia section)
Ringer lactate and hartsol is same ?
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Ringer's Lactate vs Hartmann's Solution — Are They the Same?
Almost the same — but not identical. They are often used interchangeably, and in clinical practice the names are frequently treated as synonyms.
The History
- Ringer's solution was originally developed by Sydney Ringer in the 1880s (Na⁺, K⁺, Ca²⁺, Cl⁻)
- Hartmann's solution was developed in 1932 by Alexis Hartmann, who added lactate to Ringer's solution to treat acidosis in children — hence Lactated Ringer's (LR)
So Hartmann's solution IS Ringer's Lactate — same concept, same origin story.
Composition Comparison
| Component | Ringer's Lactate (US) | Hartmann's Solution (UK/India) |
|---|---|---|
| Na⁺ | 130 mmol/L | 131 mmol/L |
| K⁺ | 4 mmol/L | 5 mmol/L |
| Ca²⁺ | 2.7 mmol/L | 2 mmol/L |
| Cl⁻ | 109 mmol/L | 111 mmol/L |
| Lactate | 28 mmol/L | 29 mmol/L |
| Osmolarity | 273 mOsm/L | ~278 mOsm/L |
Key Points
- Clinically identical — both are balanced, isotonic crystalloids used for the same indications (IV preload, fluid resuscitation, maintenance)
- Minor compositional differences exist between brands/regions — negligible in practice
- In India, the fluid labeled "Ringer Lactate" on the bag is essentially Hartmann's solution
- Both are superior to Normal Saline for large-volume resuscitation (avoid hyperchloremic acidosis)
- "Hartsol" is simply a brand name for Hartmann's Solution / Ringer's Lactate manufactured by certain companies (e.g., Baxter India) — same fluid, different label
"Other options are buffered crystalloid solutions (e.g., Ringer's lactate, Hartmann's solution, Plasma-Lyte)." — Harrison's Principles of Internal Medicine, 22e
So for your epidural anesthesia preload in PFN surgery — RL / Hartmann's / Hartsol are all the same fluid and equally appropriate.
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