Saddle block versus subarachnoid block for transurethral resection of prostate surgery: A randomized comparative study

Abstract

Background: Regional anesthesia is usually preferred over general anesthesia for transurethral resection of the prostate (TURP). Spinal anesthesia increases the risk of hypotension. Saddle block provides a block that is dense in lumbosacral and lower thoracic dermatomes; hence, hemodynamic derangement will be less. In this study, we aimed at comparing the hemodynamic stability and anesthetic efficacy of subarachnoid block versus saddle block in patients undergoing TURP. Patients and Methods: After obtaining written informed consent, a prospective randomized comparative study was conducted in 90 patients, 50–70 years, of ASA physical status 1–2 scheduled for TURP. They were randomly allocated into two groups of 45 each. Group SA received spinal and Group SB received saddle block using the same volume (2.5 ml) of hyperbaric bupivacaine. Hemodynamic parameters such as heart rate (HR), systolic, diastolic, and mean arterial blood pressure (BP), and height of block were recorded in both groups. If hypotension was present, ephedrine bolus intravenously was administered, and the total requirement of vasopressor was noted. Results: Maximum decrease in HR from baseline was low in Group SB (P = 0.008). Maximum fall in systolic, diastolic, and mean BP was also found to be low (P = 0.005), (P = 0.001), and (P = 0.001), respectively, in Group SB. In Group SB, time to achieve T10 sensory level was delayed, whereas the level of motor blockade was low according to the modified Bromage score. Ephedrine consumption was also low in Group SB (P = 0.001) versus Group SA. Conclusion: Saddle block can be safely administered in TURP for elderly patients, with the reduced hemodynamic imbalance and vasopressor requirement.