Background
Elderly patients undergoing transurethral resection of the prostate (TURP) may have preexisting cardiac or cerebral dysfunction. Maintaining hemodynamic stability is essential. The objective of this study was to compare the anesthetic efficacy and cardiovascular stability of a subarachnoid injection of 7.5 mg hyperbaric bupivacaine at the level of T12–L1 to 15 mg hyperbaric bupivacaine injected at the level of L3–4 for elderly patients undergoing TURP.
Methods
Fifty patients undergoing TURP were enrolled. Patients were randomized to either of two groups: Group I: Dural puncture was performed in the midline at the T12–L1 interspace. 7.5 mg of hyperbaric bupivacaine (1.5 ml of 0.5% solution) was then injected through a 16 gauge/26 gauge combined spinal–epidural by “needle through needle” technique. Group II: Dural puncture was performed in the midline at the L3–4 interspace. Fifteen milligrams of hyperbaric bupivacaine (3 ml of 0.5% solution) was then injected through a 25-gauge spinal needle. Demographic data, prostate size, volume of irrigation fluids, hemodynamic parameters, block characteristics, and complications were recorded.
Results
Demographic data, prostate size, volume of irrigating fluids, complications and duration of surgery were comparable in both groups.
Conclusion
Injection of 7.5 mg hyperbaric bupivacaine at the level of T12–L1 is sufficient to provide adequate sensory block while maintaining hemodynamic stability for TURP. This dose and injection location may offer an additional advantage of decreased duration of motor block in patients undergoing TURP.