Low dose lignocaine + butorphanol vs. low dose bupivacaine for spinal anaesthesia in day care urological surgeries: a prospective randomized control trial

Abstract

A local anaesthetic with fast onset, short and reliable duration of anaesthesia may be preferable for day care urological surgeries. Low dose lignocaine is believed to act faster and to have a shorter duration of action than low dose bupivacaine. Use of lignocaine for spinal anesthesia is discouraged now a days because of rare reports of transient neurological symptoms. The purpose of this study was to compare effectiveness and safety of low dose of lignocaine + butorphanol against low dose of bupivacaine for day care urological surgeries. A prospective randomized control trial was conducted between December 2012 to November 2015. After taking ethical committe approval and patient consent, total 990 patients were randomized in two groups. Group A received 0.5 mL of 5% lignocaine (25 mg) + 0.3 mL butorphanol (0.3 mg) and group B received 1 mL of 0.5% bupivacaine (5 mg) for spinal anesthesia. Spinal anesthesia was given at the L3-L4 interspace with the patient in the sitting or lateral position. The criteria for evaluation were time till onset of sensory and motor block, duration of sensory and motor block, time till ambulation, time till fit for discharge and any complications. Both the groups were comparable in terms of age, male to female ratio, American Society of Anesthesiologists (ASA) grade and duration surgery. Group A and Group B were statistically different in terms of mean time till onset of sensory block (120±22 sec and 274±36 sec), onset of motor block (228±34 sec and 372±41 sec), duration of sensory block (100±21 min and 230±28 min), duration of motor block (60±15 min and 152±23 min), time till ambulation (138±24 min and 292±48 min), time till fit for discharge (256±35 min and 428±46 min) respectively (<0.0001). Nausea, vomitings, hypotension, bradycarida and pruritis were less in group A compared to group B (<0.01). None of patient in any group had temporary or permanent neurological defecit. Spinal anaesthesia is an effective as well as a safe modality to anaesthetize the patient for day care urological procedures. This study shows lignocaine + butorphanol is preferable over bupivacaine for spinal anesthesia for day care urological procedures. It also favours day care surgery at remote areas with lesser medical facilities. It helps to minimize requirement of medical and paramedical staff, thus further extending scope of day care urological surgeries.