JOURNAL OF CLINICAL AND BIOMEDICAL SCIENCES

Abstract

Background: The elderly are vulnerable to the toxic effects of drugs and have an increased sensi-tivity to many agents due to the age-related physiological changes and the increased associated co-morbidity. Hence many alterations to anaesthetic techniques are made and in use to address the potential complications following surgeries in the elderly patients. Evidences on the efficacy of low doses of the an-aesthetic bupivacaine when added with an opiod fentanyl in spinal anaesthesia (SA) in Indian elderly pa-tients who undergo transurethral resection of the prostate (TURP) is sparse. Aim: The objectives are to compare the degree of the sensory and motor block in elderly patients undergoing TURP under SA with lower doses of bupivacaine. Materials and Methods: A randomized controlled study was done on forty elderly men who were aged 60 years or older and scheduled to undergo TURP. Two comparable groups of patients were administered intrathecally either with bupivacaine 7.5 mg and fentanyl 25 μg (group I) or bupivacaine 5.0 mg and fentanyl 25 μg (group II). Sensory blockage was assessed by pinprick testing at pre-determined intervals in the mid-clavicular line until the block regressed to L2 dermatome level. Modified Bromage scale was used to assess the motor block until the score was recorded zero. Results: The median peak level of sensory block recorded was at T7 and T8 among patients in group I and II respectively (p = NS). The mean time to L2 level regression was recorded at 159 vs 171 min (p = NS). Motor block was signifi-cantly intense in patients in group I in terms of mean duration of complete recovery of the block (P < 0.001). Grade III block was 100% vs 45% in group I and II respectively. Conclusions: We found that 5.0 mg of bupi-vacaine with 25 μg of fentanyl provides satisfactory anaesthesia for performing TURP in the elderly.

Keywords: Spinal anaesthesia, TURP, elderly, bupivacaine, fentanyl, sensory blockade, motor blockade