Intrathecal Anaesthesia for Elderly Patients Undergoing Short Transurethral Procedures: A Dose-Finding Study.

ABSTRACT

Background: To reduce effects associated the adverse hemodynamic effects associated with the spinal anesthesia– induced medical sympathectomy, combinations of very small doses of local anesthetic and adjuvant opioids are frequently administered. However, for elderly patients undergoing transurethral procedures, the optimal bupivacaine-fentanyl dose is unknown. The aim of the study is to find the optimal dosage of intrathecal anesthesia for elderly patients undergoing short transurethral procedures with bupivacaine–fentanyl, with stable hemodynamics. Methods: The study included 75 patients, ASA I, II and III scheduled for transurethral procedures at Kamineni hospitals, L.B. Nagar, Hyderabad which is a 350 bedded super-speciality tertiary care center. These patients were randomly allocated into three groups, 25 patients in each group. Group A received 7.5 mg bupivacaine, Group B were given 5 mg bupivacaine along with fentanyl 20 μg while patients in Group C received bupivacaine 4 mg with fentanyl 20 μg. Intrathecal fentanyl as an analgesic adjuvant to bupivacaine anesthesia. Intraoperative pain was assessed using Visual Analog Scale (VAS). Demographics, time intervals, and continuous variables (MAP, heart rate, SpO2, VAS) were analyzed using the one-way analysis of variance (ANOVA) test. Results: Demographic characteristics as well as intraoperative MAP, heart rate and SpO2 were similar among groups. Intraoperative rescue fentanyl requirements were significantly higher in group C (bupivacaine 4 mg + fentanyl 20μg) when compared with those in the other two groups. In group A (bupivacaine 7.5 mg), there was significant difference in mephenteramine requirements. Conclusion: Of the doses investigated bupivacaine 5 mg with fentanyl 20μg, provided adequate analgesia and was associated with hemodynamic stability and the fewest side effects.