Comparative study between continuous epidural anaesthesia and continuous Wiley Spinal® anaesthesia in elderly patients undergoing TURP

Abstract

Background: This study compared haemodynamics of continuous Wiley Spinal® anaesthesia with continuous epidural anaesthesia in elderly patients undergoing transurethral resection of prostate (TURP). Methods: After Institutional Review Board approval, thirty elderly male patients undergoing TURP classified as ASA physical status II or III were assigned into either the following: Continuous Epidural Anaesthesia group (Group CEA) receiving fentanyl 50 μg with plain bupivacaine 0.5% in 5 ml boluses or Wiley Spinal® Anaesthesia group (Group WSA) receiving fentanyl 5 μg with plain bupivacaine 0.5% given as 0.5 ml boluses until reaching sensory level of T10. Sensory and motor block onset and recovery, haemodynamics, time to first analgesia and adverse events were documented. Results: On reviewing WSA and CEA groups, onset of T10 sensory block [2 (1–8) vs. 5 (3–20) min], and motor block [9 (2–25) vs. 12 (5–40) min], with sensory recovery [161.7 ± 28.3 vs. 253.3 ± 52.7 min] and motor block duration [100.0 ± 27.4 vs. 130.7 ± 19.5 min] respectively (P < 0.05) being shorter in Group WSA. Haemodynamics revealed significant reduction in mean arterial pressure after three and five minutes of injection of local anaesthetic and heart rate after fifteen minutes in Group WSA when compared with Group CEA (P < 0.05). Time to first analgesia and adverse events were non-significant. Conclusion: In elderly patients undergoing TURP, continuous Wiley Spinal® anaesthesia showed nearly comparable haemodynamics as continuous epidural anaesthesia with minimal adverse effects. This technique also provided good anaesthetic profile as well as fast sensory and motor block onset and recovery.

Keywords

• Haemodynamics
• Wiley Spinal®
• Epidural
• Elderly
• TURP