A comparative study of low-dose intrathecal bupivacaine 0.5% (heavy), levobupivacaine 0.5% (plain), and levobupivacaine 0.5% (heavy) with fentanyl as an adjuvant in transurethral resection of prostate surgery: A prospective randomized study

Abstract

Background: Spinal anesthesia is the technique of choice for transurethral resection of the prostate (TURP) surgeries. Levobupivacaine, an S-enantiomer of bupivacaine, is less cardiotoxic than bupivacaine; therefore, a low dose of local anesthetic with fentanyl as an adjuvant has been used to decrease toxicity and increase efficacy. Aims and Objectives: The aim of this study was to compare and evaluate the efficacy of hyperbaric bupivacaine 0.5%, isobaric levobupivacaine 0.5%, and hyperbaric levobupivacaine 0.5% with fentanyl as an adjuvant. Materials and Methods: One hundred and five patients scheduled for elective TURP surgeries were randomly divided into three groups. Group BH (n=35) received 1.5 mL of 0.5% hyperbaric bupivacaine with 25 μg of fentanyl, Group LH (n=35) received 1.5 mL of 0.5% hyperbaric levobupivacaine with 25 μg of fentanyl, and Group LP (n=35) received 1.5 mL of 0.5% isobaric levobupivacaine with 25 μg of fentanyl intrathecally. Results: The onset of sensory and motor block was earlier and the duration of analgesia and motor block were longer in the BH group (P0.05). The visual analog scale score was higher in the LP group. Hypotension, nausea, and vomiting were seen in the BH group. Conclusion: Hyperbaric is better than isobaric group due to quicker onset and longer duration. Levobupivacaine is better than bupivacaine in terms of the early mobilization and a lesser incidence of side effects, making hyperbaric levobupivacaine a better alternative to isobaric levobupivacaine and hyperbaric bupivacaine.

Keywords

• hyperbaric; isobaric; levobupivacaine; bupivacaine; intrathecal fentanyl; spinal anesthesia; transurethral resection of the prostate