Randomised comparison of haemodynamics in spinal block with hyperbaric bupivacaine in sitting versus lateral decubitus position for transurethral prostatectomy

Abstract

Spinal anaesthesia is a commonly used anaesthetic technique for transurethral resection of the prostate for its efficiency, speed, minimal effects on mental state, protection against thromboembolic complications, early mobilisation after surgery, minor respiratory complications, continuous analgesia and shorter hospital stay. Objective: To determine whether administration of hyperbaric bupivacaine in spinal anaesthesia in sitting position causes minor changes in blood pressure and heart rate compared to the lateral decubitus position. Methodology: Prospective, longitudinal, comparative, randomised study. A total of 50 patients were included in two groups. Group A (n = 23) patients were administered 12.5 mg of hyperbaric bupivacaine in the sitting position and the position was maintained for 5 min. Group B (n = 27) patients were administered 12.5 mg of hyperbaric bupivacaine in lateral decubitus position. Blood pressure, heart rate, and levels and latency of sensory and motor block were compared. Descriptive statistics were used and analysed by Student's “t” test to compare the means of the values found. Results: There were no significant differences in heart rate and systolic blood pressure. Diastolic blood pressure was higher in group A, showing a significant difference from 5 min after administration of the block, with a significant difference in mean arterial pressure from minute 10. The onset of sensory and motor blockade was faster, and the level of sensitive block achieved higher, in group B. The regression of the motor block was faster in group A. Conclusions: There were significant differences in mean and diastolic blood pressure as well as onset of sensory and motor block with the sitting position. This proves that applying spinal anaesthesia in a sitting position involves less haemodynamic variation (heart rate and blood pressure) for elderly patients undergoing transurethral resection of prostate.

Keywords

• Spinal anaesthesia
• Transurethral resection of the prostate
• Sitting position
• Lateral decubitus position