Spinal anesthesia for endoscopic urological surgery--low dose vs. varying doses of hyperbaric bupivacaine.
OBJECTIVE
The aim of this study is to compare the efficiency of low dose vs. varying doses of hyperbaric bupivacaine in spinal anesthesia for endoscopic urological procedures.


METHODS
Sixty consecutive patients were studied in a randomized prospective manner. They received either of 5 (Gr I), 7.5 (Gr II) or 10 mg (Gr III) of hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl, through a 25-gauge W hitacre spinal needle placed in the L3-L4 interspace. Characteristics of sensory and motor block, dose of ephedrine required, secondary effects, the patients, and the surgeons satisfaction, were noted.


RESULTS
The maximum number of blocked segments was 14 +/- 1 (Gr I), 15 +/- 2 (Gr II) and 16 +/- 2 (Gr III). Time to T12 regression was significantly shorter for Gr I (53 +/- 13 min) than for Gr II (69 +/- 20 min) or Gr III (94 +/- 14 min). Bromage 3 block was not found in Gr I compared to 4 patients in Gr II and 15 patients in Gr III. The duration of motor block was shorter in Gr 1(51 +/- 18 min) than in Gr II (86 +/- 19 min) and in Gr III (138 +/- 21 min). Ephedrine was used for 16 patients in Gr III (9.8 +/- 12.2 mg), 5 patients in Gr II (3.7 +/- 7.8 mg) and 2 patients in Gr I (0.5 +/- 1.5 mg). The difference is statistically significant between Gr III and the other groups.


CONCLUSIONS
These results suggest that the use of a low dose of bupivacaine (5 mg) added to fentanyl (25 microg) for endoscopic urological surgery, resulted in short-acting sensory block, without motor block and a lower incidence of cardiovascular side effects, as compared to either of 7.5 or 10 mg bupivacaine with 25 microg fentanyl.
Labbene
Iheb
I
Military Hospital of Tunis, Department of Anesthesiology and Critical Care, Tunis, Tunisia. iheb.labbene@fmt.rnu.tn
Lamine
Khaled
K
Gharsallah
Hedi
H
Jebali
Adel
A
Adhoum
Anis
A
Ghozzi
Samir
S
Ben Rais
Nawfel
N
Ferjani
Mustapha
M
D000368:Aged; D000775:Anesthesia, Spinal / Q000379:methods*; D019162:Anesthetics, Combined / Q000008:administration & dosage / Q000627:therapeutic use; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D000779:Anesthetics, Local / Q000009:adverse effects / Q000627:therapeutic use*; D001794:Blood Pressure / Q000187:drug effects; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002045:Bupivacaine / Q000009:adverse effects / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004724:Endoscopy / Q000379:methods*; D004809:Ephedrine / Q000008:administration & dosage; D005283:Fentanyl / Q000008:administration & dosage; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D011446:Prospective Studies; D011467:Prostate / Q000601:surgery; D013997:Time Factors; D016896:Treatment Outcome; D001743:Urinary Bladder / Q000601:surgery; D013520:Urologic Surgical Procedures / Q000379:methods*
D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D001993:Bronchodilator Agents; D004809:Ephedrine; D005283:Fentanyl; D002045:Bupivacaine