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Transurethral resection of the prostate (TURP) with low dose spinal anesthesia in outpatients: a 5 year review
Busara Sirivanasandha1, Pamela H Lennox, Himat Vaghadia
1Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Canada.
Introduction:
Spinal anesthesia for ambulatory transurethral resection of the prostate (TURP) is a well established technique. The following study examines data over a 5 year period at a major Canadian tertiary academic center. The purpose of the study is to review our experience and complications associated with spinal anesthesia using combined low dose local anesthetic + narcotic for ambulatory TURP procedures.
Methods:
Medical records were reviewed retrospectively on all ambulatory TURP patients over a 5 year period between January 2000 and September 2005 in our Surgical Day Care Center. All spinal anesthetics were reviewed and based on dosage, classified into low dose bupivacaine (< 10 mg; Group LD-B), conventional dose lidocaine (> 35 mg; Group CD-L) or low dose lidocaine (≤ 35 mg; Group LD-L). Primary end points of interest were duration of spinal block and duration of postanesthesia care unit (PACU) stay.
Results:
A total of 1064 TURPs were performed during the study period. Within this cohort of 334 spinal anesthetics administered, 27 were excluded for lack of data leaving 307 cases for analysis. Patient demographics were normally distributed. Mean doses of spinal local anesthetics administered were: Group LD-B 7.3 ± 2 mg, Group CD-L 52.2 ± 13 mg and Group LD-L 29 ± 5.2 mg. Intrathecal fentanyl was often added to the local anesthetic as an adjunct. Block regression times (Group LD-B 273 ± 98 mins, Group CD-L 174 ± 47 mins and Group LD-L 159 ± 45 mins) and discharge times (Group LD-B 309 ± 94 mins, Group CD-L 230 ± 71 mins and Group LD-L 227 ± 75 mins) were significantly lesser in both lidocaine groups compared to Group LD-B (p <0.05). The frequency of prolonged spinal blocks (> 3 hr) in Groups LD-L, CD-L and LD-B was 23%, 43% and 83% respectively (p < 0.05).
Conclusion:
Low dose spinal anesthesia with bupivacaine and lidocaine were well tolerated for short duration TURP. Low dose bupivacaine and conventional dose lidocaine were associated with significantly longer block duration, longer PACU stay and higher frequency of prolonged blocks compared with low dose lidocaine for spinal anesthesia.
