Abstract
To evaluate the effects of two different spinal isobaric levobupivacaine doses on spinal anesthesia characteristics and to find the minimum effective dose for surgery in patients undergoing transurethral resection (TUR) surgery. Fifty male patients undergoing TUR surgery were included in the study and were randomized into two equal groups: Group LB10 (n=25): 10 mg 0.5% isobaric levobupivacaine (2 ml) and Group LB15 (n=25): 15 mg 0.75% isobaric levobupivacaine (2 ml). Spinal anesthesia was administered via a 25G Quincke spinal needle through the L3-4 intervertebral space. Sensorial block levels were evaluated using the 'pin-prick test', and motor block levels were evaluated using the 'Bromage scale'. The sensorial and motor block characteristics of patients during intraoperative and postoperative periods and recovery time from spinal anesthesia were evaluated. In three cases in the Group LB10, sensorial block did not reach the T10 level. Complete motor block (Bromage=3) did not occur in eight cases in the Group LB10 and in five cases in the Group LB15. The highest sensorial dermatomal level detected was higher in Group LB15. In Group LB15, sensorial block initial time and the time of complete motor block occurrence were significantly shorter than Group LB10. Hypotension was observed in one case in Group LB15. No significant difference between groups was detected in two segments of regression times: the time to S2 regression and complete sensorial block regression time. Complete motor block regression time was significantly longer in Group LB15 than in Group LB10 (p<0.01). Our findings showed that the minimum effective spinal isobaric levobupivacaine dose was 10 mg for TUR surgery.
Highlights
Endoscopic surgical interventions are preferred over open surgery methods because of the ease of application and the shorter hospital discharge times
In Group LB15, sensorial block initial time and the time of complete motor block occurrence were significantly shorter than Group LB10
Complete motor block regression time was significantly longer in Group LB15 than in Group LB10 (p
Summary
Endoscopic surgical interventions are preferred over open surgery methods because of the ease of application and the shorter hospital discharge times. Most of these patients have a risk of severe respiratory and cardiovascular diseases due to advanced age. Spinal anesthesia is the widely preferred anesthesia method for urologic surgical interventions because complications are seen less frequently compared to general anesthesia [1,2,3,4]. All three forms are used in various surgical interventions and delivery, including spinal anesthesia, epidural analgesia, postoperative pain management and peripheral blocks [7, 8]. Levobupivacaine is more favorable compared to bupivacaine and ropivacaine in terms of cardiovascular and central nervous system toxicity, which has been proven in preclinical and clinical studies [9,10,11]
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