European Journal of Cardiovascular Medicine

Purpose: The study's primary objective is to compare the conventional dose of bupivacaine and a low dose of bupivacaine-fentanyl spinal anaesthesia in maintaining hemodynamic stability in patients undergoing TURP with a satisfactory sensory blockade. Methodology: Patients posted for elective TURP surgery were divided into two groups of 47 each. Group F (n=47) consisted of patients who received low-dose bupivacaine–fentanyl spinal anaesthesia[bupivacaine 5 mg with fentanyl 25mcg+ normal saline 0.5 ml]. And group B (n=47) consisted of patients who received a conventional dose of bupivacaine[bupivacaine 75 mg + normal saline 0.5 ml]. A combined spinal epidural technique was used. The peak dermatomal level of sensory block, the time to reach this level, motor blockade at the time of reaching peak sensory level, time to two-segment regression, and time to S2 sensory regression were recorded. Motor blockade was assessed with a Bromage scale(0=no motor block,1=hip blocked,2=hip and knee blocked,3=hip, knee, and foot blocked). Duration of motor block was considered as the time when Bromage score returned to zero. The pain was assessed every 10 minutes from the beginning of surgery using a 10-cm visual analogue pain scale. Adverse effects if any were recorded. Outcome variables were the level of segmental spinal block and any adverse events like a decrease in BP or decrease in Heart rate. Results: The peak sensory level attained in both groups was similar and adequate for surgery but the time to reach peak level was found to be significantly faster with the conventional dose. Two-segment regression difference and duration between the groups were not found to be statistically significant though the S2 regression was found to be faster in the conventional dose group and statistically significant. This was even though a lower dose was used in group B. The occurrence of hemodynamic instability (hypotension, bradycardia) was more in group B compared to group F, in which patients received low-dose bupivacaine(1mg) combined with 25mcg fentanyl. The occurrence of hypotension was 42.6% in group A compared with 29.8% in group B. The occurrence of bradycardia was 23.4% in group B compared with 12.8% in group F.Sensory block was adequate for all surgery in both groups. Conclusion: Low-dose bupivacaine with fentanyl spinal anaesthesia used in TURP cases decreases the occurrence of hemodynamic instability (hypotension and bradycardia) in elderly patients while providing adequate sensory block for the procedure