Effects Of Isobaric Bupivacaine In Endoscopic Urological Surgeries Under Spinal Anaethesia
Keywords:Isobaric bupivacaine, subarachnoid block, hyperbaric
Introduction: Isobaric bupivacaine is not routinely practiced as a subarachnoid block, though it may be used as an alternative to traditional hyperbaric solution with less complications and a good operative condition in endoscopic urologic surgery.
Objective: This prospective randomized study was conducted over a period of 18 months to evaluate the effects of isobaric bupivacaine with low dose fentanyl in endoscopic urologic surgeries under spinal anaesthesia.
Methods: Two equally sized groups (n=60) of male patients were randomly selected and studied for routine endo-urological surgeries under subarachnoid block. One group received 0.5% hyperbaric bupivacaine (HBF) and the other group received 0.5% isobaric bupivacaine (IBF). In both groups bupivacaine was mixed with low dose fentanyl (10 microgram) and 1 ml distilled water. Non-invasive blood pressure, heart rate, SpO2, levels of sensory and motor blockade were recorded frequently. Complications of intrathecal block (if developed) were also recorded and treated.
Results: The mean operation time was 49.9±9.55 and 50.10.10±7.98 minutes in HBF and IBF groups respectively and the difference was not statistically significant (p>0.05). The mean time to request for first analgesic was 402.50 ± 37.21 and 288.90±25.22 minutes in HBF and IBF groups respectively and the difference was statistically significant (p<0.001). There was no difference in the level of sensory block and total amount of fluid infused (p>0.05). Base line heart rate and blood pressure of the two studied groups were similar. After the subarachnoid block blood pressure reduced significantly in both the groups (p<0.001) but remained within the acceptable level for the surgery. No significant differences in complications like shivering, nausea, vomiting, hypotension, bradycardia were observed in the groups.
Conclusion: Intrathecal isobaric bupivacaine with low dose fentanyl may be used as an alternative to traditional hyperbaric bupivacaine for endoscopic urologic surgeries with less side effects related to intrathecal opioid.
JAFMC 2011; 7(2): 33-36