Comparing the Effectiveness of Two Drug Combinations-0.5% Fentanyl and Bupivacaine versus 0.5% Hyperbaric Bupivacaine in Spinal Anaesthesia for Transurethral Resection of Prostate
Author(s) : Umbrin Naz, Hazratullah , Imranulhaq, Ambreen Sifatullah, Beena Khan & Waqar Ahmad Mishwani
This study aims to compare the performance of fentanyl and bupivacane 0.5% with hyperbaric bupivacane 0.5% as spinal anesthetics during transurethral resection of the prostate (TURP).
Material and Methods:
In the study, 50 male patients aged 55 to 75 years who were admitted for TURP at the Khyber Teaching Hospital over a one-year period from June 2019 to June 2020 were recruited. The patients were randomly allocated in a double-blind fashion in to 2-groups. Group-A got a combination of 0.5% bupivacaine and fentanyl, while Group-B received 0.5% bupivacaine alone. The effectiveness of each anesthetic is determined by examining the relative initiation and interval of both sensory and motor block. A faster onset and longer duration of sensory block is considered a better outcome, while a faster onset and shorter duration of motor block is considered the preferred outcome.
The average age of patients in Group-A was 66.6 ± 6.4 years and in Group-B was 76.3 ± 6.1 years, with no significant difference between the groups (P > 0.05). Similarly, there were no significant differences in weight, height, and body mass index (BMI) between the two groups (P > 0.05). The onset of sensory block was significantly quicker in Group-A (4.9 ± 1.1 minutes) compared to Group-B (7 ± 1.4 minutes, P < 0.05), and the regression of two sensory dermatomes was also significantly prolonged in Group-A (125.4 ± 11.8 minutes) compared to Group-B (85.2 ± 10.4 minutes, P < 0.05). The total duration of sensory block was also significantly prolonged in Group-A compared to Group-B (P = 0.00). For motor block, the onset was quicker in Group-A (8.8 ± 2.4 minutes) compared to Group-B (11 ± 2.7 minutes, P < 0.05), but the duration was extended in Group-B (189.4 ± 6.9 minutes) compared to Group-A (146.8 ± 15.4 minutes, P < 0.05) in significant manner. The prevalence of adverse effects was higher in Group-B (13 patients) compared to Group-A (8 patients, P = 0.04), and the mean dose of postoperative analgesics was lower in Group-A (P = 0.035). No significant variance was found in the heart rate and systolic blood pressure during the procedure between the groups examined (P > 0.05).
Given the longer duration of sensory block, shorter duration of motor block and reduced postoperative analgesic requirements, of 0.5% buipvacaine and fentanyl compared to hyperbaric bupivacaine, it seems that this drug can be used as an appropriate spinal anaesthetic for patients receiving TURP.
Keywords: Bupivacaine and fentanyl, prolonged sensory block, reduced motor block, spinal anaesthesia, TURP.