[Spinal anesthesia with bupivacaine in lower urologic surgery. Our experience apropos of 500 cases]

Rachianesthesia was used for 500 lower urinary tract operations, including 50 repeat procedures, the anesthetic employed being bupivacaine. Patients were frequently hypertensive and presented cardiopathies, usually ischemic in origin. The surgical procedure generally involved transurethral prostate resection for adenoma or carcinoma, or endoscopic resection of a bladder tumor, and all patients received preventive heparin therapy using Kakkar's method. Induction of anesthesia occurs between 30 seconds and one minute after completing the injection a procedure lasting 2 to 5 minutes. Full anesthesia is obtained after 2 to 3 minutes, and is maintained during the mean operation period of 69 +/- 32 minutes by regular intraspinal injections of anesthetic. Results were perfect in 425 cases, 48 patients required additional sedatives, 23 a potent analgesic and 4 a general anesthetic after an operating time extending beyond 100 minutes heart rate remained fairly regular while diminishing slightly in frequency (an average of 4 beats/min). The fall in blood pressure was globally moderate (296 patients) and was unaltered in 204 cases. Hemodynamic modifications lasted for 3 à 4 minutes only and were corrected by appropriate therapy. Postoperative complications were mainly of the headache type (26 cases: 5%), but three patients developed angina from a coronary ischemic accident. Myocardial infarction was not observed, and no particularly incidents were reported in the 32 patients requiring repeat rachianesthesia. The simple execution and efficacy of this mode of anesthesia is emphasized, an additional need for general anesthesia being a rare event. The compound is well tolerated, hemodynamic modifications are moderate and neurological sequelae lacking. Rachianesthesia with bupivacaine appears to be among the methods of choice for lower urinary tract surgery.