Selective Spinal Anesthesia Using 1 mg of Bupivacaine with Opioid in Elderly Patients for Transurethral Resection of Prostate

ABSTRACT

PURPOSE: This study was to evaluate the characteristics of selective spinal anesthesia using 1 mg of bupivacaine combined with fentanyl or sufentanil in elderly patients undergoing transurethral resection of prostate. MATERIALS AND METHODS: Fifty-six patients were randomized into two groups. The Fentanyl group received 0.5% hyperbaric bupivacaine 0.2 mL+fentanyl 20 microg+5% dextrose 1.4 mL, and the Sufentanil group received 0.5% hyperbaric bupivacaine 0.2 mL+sufentanil 5 microg+5% dextrose 1.7 mL intrathecally. Intraoperative and postoperative characteristics were evaluated. Patient satisfaction was assessed postoperatively. RESULTS: Twenty-six patients in each group completed the study. The median peak sensory block level was similar between two groups, but sensory regression time was longer in the Sufentanil group than the Fentanyl group (p=0.017). All patients were able to move themselves to the bed without any aid when they arrived at the admission room. Pain scores were lower in the Sufentanil group than the Fentanyl group at postoperative 6, 12, and 18 hours (p=0.001). Compared to the Fentanyl group, the Sufentanil group required less postoperative analgesia (p=0.023) and the time to the first analgesic request was longer (p=0.025). Twenty-four of 26 patients (92.3%) in each group showed "good" satisfaction level. CONCLUSION: Selective spinal anesthesia using 1 mg of bupivacaine with fentanyl or sufentanil provided appropriate sensory block level with spared motor function for transurethral resection of the prostate in elderly patients. Intrathecal sufentanil was superior to fentanyl in postoperative analgesic quality.