COMPARISON OF 0.5% LEVOBUPIVACAINE AND 0.5% BUPIVACAINE WITH FENTANYL FOR SPINAL ANAESTHESIA FOR TRANSURETHRAL RESECTION OF PROSTATE / BLADDER TUMOUR: A PROSPECTIVE RANDOMIZED AND CONTROLLED CLINICAL STUDY.

Abstract

Background – The aim of this study is to compare safety and efficacy of bupivacaine 0.5% of 2ml (10mg) with 25mcg fentanyl and levobupivacaine 0.5% of 2ml with 25mcg fentanyl when given intrathecally in patients of Transurethral Resection of Prostate/Bladder Tumor Surgeries

Methods–After local ethics committee approval,60 patients were selected according to eligibility criteria and a written informed consent was obtained from each patient after explaining the technique prior to inclusion in this study in their own vernacular language and randomly allocated in two groups of 30 each. GROUP I: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl intrathecally to achieve an adequate level of anaesthesia.GROUP II: patients received 2 ml(10 mg) 0.5% bupivacaine with 25 mcg fentanyl inrathecally to achieve adequate level of anaesthesia.Spinal block was performed by an anaesthesiologist consultant. Patients were monitored for sensory blockade,motor blockade,Ramsay sedation score,VAS score and complications. Hemodynamics were compared in both the groups.

Observations –In this study we evaluated and compared 0.5% bupivacaine and fentanyl with 0.5% levobupivacaine and fentanyl in terms of intraoperative hemodynamic changes, onset & duration of sensory block, onset of motor block, level of sedation and occurance of complications when given intrathecally for transurethral resection of prostate/bladder tumors.It was observed that sensory blockade qualities were comparable in both the groups. However, motor blockade was significantly reduced in group-II(Levobupivacaine) as compared to groupI(Bupivacaine). Patients in Group II had better hemodynamic stability,good patient and surgeon satisfaction and fewer side effects as compared to Group I.

Conclusion –0.5% Levobupivacaine plus fentanyl provides less motor blockade,better hemodynamic stability and fewer side effects in patients undergoing TURP/TURBT compared to 0.5% bupivacaine plus fentanyl.