Effectiveness Of Saddle Block Vs Spinal Anaesthesia In Turp: An Open Label Randomized Control Trial.

BACKGROUND: One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. METHODS: This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45-65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients' parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients' other parameters including age, surgery duration and comorbidity were also recorded. RESULTS: Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia. CONCLUSIONS: Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.

The economics of fragility fractures in West Virginia.

Compared to the United States, West Virginia has a higher proportion of residents aged 60 or older. This situation creates a stronger risk factor for osteoporosis and subsequent fragility fractures. The widespread availability of bone densitometry screening to identify osteoporosis and the marketing of effective agents to reduce fractures in the past decade has resulted in cost savings. We estimated the absolute number of fragility fractures associated with osteoporosis in West Virginia and projected their costs over a 5-year period. Cost savings were based on the variables of the proportion of osteoporotic patients identified and their long-term adherence to prescribed calcium,vitamin D, and bisphosphonate therapy. Our results indicate that only a small amount of potential cost savings (varying between less than 0.5% to 3.0%) is currently realized through diagnosis and adherence to prescribed treatment. We conclude that increased screening and recognition of osteoporosis by the primary care provider is a more feasible strategy to improve cost savings and fracture reduction rather than attempts to improve treatment adherence.