Introduction: The patients undergoing transurethral prostatectomy are elderly with co- existing cardiac and respiratory diseases with compromised reserves. Spinal anaesthesia is the mostly used technique for this procedure due to the advantageous of earlier recognition of signs and symptoms of water intoxication, fluid overload, perforation and also elderly patients tolerate regional anaesthesia better. In this study the efficacy of 0.5% hyperbaric Bupivacaine (7.5mg) and 0.5% hyperbaric Bupivacaine (5mg) with 25 µg of Fentanyl given intrathecally were compared.

Materials and Methods: The patients were randomly allocated into 2 groups, each having 50 patients. Group A: receiving 1.5ml of 0.5% hyperbaric bupivacaine (7.5mg) Group B:receiving 1ml of 0.5% hyperbaric bupivacaine+25 μg fentanyl. Standard subarachanoid block was performed with 27G Quinckie type spinal needle in sitting position in L3-L4 space after infiltrating the space with 2cc of 2%lignocaine and drugs were injected after checking the free flow of csf   under strict aseptic conditions. observations were recorded and the results were analysed statistically.

Results: Addition of Fentanyl 25µg to Bupivacaine resulted in significant faster onset of sensory block(mean time 2.35 minutes as compared to 3.51minutes in group1) and motor block ( mean time of 5.26 minutes as compared to 6.39minutesin group1).  The time taken to reach T10 dermatomal level was also faster in group II, though the maximum height of sensory block achieved was comparable in both groups. Time for two segment regression was faster in group II and was significant. Duration of analgesia was significantly prolonged in group II (mean duration 0f 714.7minutes as compared to 177.28minutees in group1).

Conclusion: It is concluded that intrathecal Fentanyl 25µg with 5mg of hyperbaric Bupivacaine provides adequate and satisfactory anaesthesia for TURP.

Keywords: Spinal anaestheia, TURP, Fentanyl.

1. Kararmaz, S.Kaya, S.Turhanoglu et al low dose Bupivacaine Fentanyl spinal anaesthesia in transurethral prostatat-ectomy. Anaesthesia, 2003;58:526-530.
2. K.S, Pihlajamaki.k.k, Pitkanen MT et al :The use of Bupivacaine and Fentanyl for spinal anaesthesia for urologic surgery.Anaesthesia and Analgesia.2000; 91:1452-6
3. Saryela PJ, Halomen PM, Kortula Comparison of 9mg of intrathecal plain and hyperbaric Bupivacaine both with Fentanyl for caesarean delivery. Anaesthesia and Analgesia .1999;89:1257-67.
4. Tejwani GA, Pattan AK, Donald JS. Role of spinal opioid receptors in the antinociceptive interactions between intrathecal morphine and Bupivacaine Anaesthesia and Analgesia.1992;4:726-34.
5. Wange , Chakrabarti MK, Whitwam JG, specific enhancement by Fentanyl on the efforts of intrathecal Bupivacaine on nociceptive afferent but on sympathetic afferent pathways in dogs. Anaesthesiology; 1993; 41:807-12
6. Carpenter RL. Hyperbaric lignocaine spinal anaesthesia: do we need an alternative. Anesth Analg 1995;81:1125-8
7. Tarkkilla, J.Huttala and M.Tuomien. Transtient radicular irritation after spinal anaesthesia with hyperbaric 5% Lignocaine. Br.J.Anaesth 1995;74:328-29.
8. Gentilim, senlis H, Houssel P et al . Single shot spinal anaesthesia with small doses of Bupivacaine . Reg Anaesth 1997; 22:511-4
9. Pain, nociception and spinal opioids receptors. Prog Neuropyschophar-mrmacol Biol Psychaitary .1984;8(4-6):571-9.
10. Ben-david B, SolomemE , Levin H et al . Intrathecal Fentanyl with small dose dilute Bupivacaine, better anaesthesia without prolonging recovery. Anesth Analg 1997; 85: 560-5.
11. Micheal J cousins, Phillip O Spinal subarachnoid neural blockade, chapter 7 in clinical anaesthesia and management of pain ,1st edition , JB lippincott ,Philadelphia USA,1980;151-9.
12. Lee JA, Atkinson RS, WattMJ Chapter 3 in sir Robert Macintosh`s lumbar puncture and spinal analgesia- Intradural and extradural, Fifth edition, Churchill livingstone,1985;38-87.
13. Lee JA ,Atkinson RS, WattMJ Chapter 2 in sir Robert Macintosh`s lumbar puncture and spinal analgesia- Intradural and extradural, Fifth edition, Churchill livingstone,1985; 88-97.
14. Hocking G ,Wildsmith JAW . Intrathecal drug spread. Br.J. Anaesth 2004;93(4): 568-78.
15. Greene NM, Physiology of spinal Anaesthesia. Third edition Willams and Wilkins, Baltimore, 1981;1-54.

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