Title: Comparison of Intrathecal Bupivacaine with and without Fentanyl for Transurethral Resection of Prostate
Author: Sheeba Franklin
DOI: https://dx.doi.org/10.18535/jmscr/v5i8.129
Abstract
Background: Opioids are being increasingly used these days as adjuvants to local anesthetics in spinal anaesthesia. The aim of this study is to compare the effects of adding fentanyl to low dose bupivacaine in spinal anesthesia for Transurethral Resection of Prostate (TURP).
Methods: In this prospective, randomized double-blind study, spinal anaesthesia was performed in 50 American Society of Anesthesiologists I-III patients aged 55-90 years old, undergoing Transurethral Resection of Prostate using 10mg hyperbaric bupivacaine 0.5%- 2 ml (Group A) or by adding fentanyl 25 μg (Group B) to 9 mg hyperbaric bupivacaine 0.5%-2 ml (Group B). These groups were compared in terms of the quality of spinal anaesthesia as well as analgesia. The primary outcome was time to 2 segment regression and corresponding motor block. Secondary outcomes were time to reach maximal upper sensory level, maximal level of sensory block, and corresponding degree of motor block. Haemodynamic variables were also assessed.
Results: The onset of motor blockade was significantly rapid in Group II as compared with Group I. Quality of analgesia was significantly better and prolonged in fentanyl group as compared with low– dose bupivacaine alone group (P= 0.000). The maximum upper level of sensory block was higher in Group II patients than Group I patients. (P = 0.023). Motor block was more intense and more prolonged in fentanyl group as compared with Group I patients. The median (minimum, maximum) time to attain maximum level of upper sensory block was 5 (2,10) and 4 (2, 6) minutes for low – dose bupivacaine and for low – dose bupivacaine with fentanyl respectively. Mean maximal level was T6-T7 and T5-T6 for low – dose bupivacaine and for low – dose bupivacaine with fentanyl respectively. Duration of block above T10 was 44 (30, 60) and 63 (30,80) minutes for Group I and Group II respectively (P=0.000).
Conclusions: Spinal anaesthesia in elderly patients using low dose bupivacaine (10 mg) combined with 25 μg fentanyl is associated with a lower incidence of haemodynamic instability, better quality and prolonged duration.
Keywords: Low- Dose Bupivacaine, Fentanyl, Transurethral Resection of Prostate.
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