title: Single intrathecal fentanyl for combined spinal epidural anesthesia confers no advantage over hemodynamic effects in elderly patients.
abstract: BACKGROUND
  Neuroaxial blockade for ambulatory transurethral resection of the prostate is a well established technique. Patients in this group are often at high risk for perioperative complications from concurrent diseases. The purpose of this study was to compare the elderly patients who received intrathecal fentanyl alone or intrathecal fentanyl plus bupivacaine or epidural anesthesia for transurethral resection of prostate surgery.
  
  
  METHODS
  Ninety-nine patients were prospectively randomized to receive fentanyl 25 microg (Group F), fentanyl 25 microg plus hyperbaric bupivacaine 2.5 mg (Group BF), or epidural anesthesia adding fentanyl 50 microg (Group E) by combined spinal epidural anesthesia technique.
  
  
  RESULTS
  The amount of local anesthetics used until when the sensorial block reached the level of T10 was significantly lower in the Group BF than in the Group E and the Group F (p < 0.001). Maximum level of sensory block was significantly lower in the Group BF than in the Group E and the Group F (p = 0.01). The time elapsed until the sensory block reached T10, the regression of sensory block to L5 level were significantly lower in the Group BF than in the Group E and the Group F (p = 0.005, p < 0.001, respectively). Compared to the basal values, mean arterial pressures were significantly lower in the Group BF than in the Group E and the Group F (p < 0.05). The occurrence of hypotension was significantly lower in the Group BF (9.4%) than in the Group E (18.2%) and the Group F (24.2%).
  
  
  CONCLUSIONS
  Intrathecal hyperbaric bupivacaine 2.5 mg plus fentanyl 25 microg administration provides shorter motor block onset time, less local anesthetic usage and adequate hemodynamic stability in elderly patients.
authors.affiliation: Department of Anesthesiology and Reanimation, School of Medicine, Inonu University, Malatya, Turkey. aytac.yucel@inonu.edu.tr
authors.forename: A
authors.initials: A
authors.lastname: Yucel
authors.forename: N
authors.initials: N
authors.lastname: Gulhas
authors.forename: M S
authors.initials: MS
authors.lastname: Aydogan
authors.forename: M A
authors.initials: MA
authors.lastname: Erdogan
authors.forename: A
authors.initials: A
authors.lastname: Beytur
authors.forename: C
authors.initials: C
authors.lastname: Tasdemir
authors.forename: M O
authors.initials: MO
authors.lastname: Ersoy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000375:Aging / Q000502:physiology; D000767:Anesthesia, Epidural / Q000379:methods*; D000775:Anesthesia, Spinal / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage* / Q000009:adverse effects; D000779:Anesthetics, Local; D001794:Blood Pressure / Q000187:drug effects; D001827:Body Height / Q000502:physiology; D001835:Body Weight / Q000502:physiology; D002045:Bupivacaine; D005283:Fentanyl / Q000008:administration & dosage* / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D020728:Transurethral Resection of Prostate
chemical_list: D018686:Anesthetics, Intravenous; D000779:Anesthetics, Local; D005283:Fentanyl; D002045:Bupivacaine