Spinal Anesthesia For Transurethral Resection Research Articles

Comparison of clinical efficacy of hyperbaric ropivacaine with hyperbaric bupivacaine in spinal anesthesia for transurethral resection of prostate: A randomized and double-blind study

Background: Ropivacaine is an ammino-amide local anesthetic agent with properties similar to bupivacaine, but its decreased lipophilicity is associated with reduced incidence of central nervous system toxicity and cardiotoxicity. This study evaluated the safety, efficacy, effects on hemodynamics and complications of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing transurethral resection of the prostate (TURP). Aims and Objectives: The aim was to evaluate the safety, efficacy, hemodynamic stability, and side effects of spinal anesthesia using 0.5% hyperbaric bupivacaine and 0.75% hyperbaric ropivacaine in patients undergoing TURP. Materials and Methods: Sixty adult patients with physical status classes I and II, as determined by the American Society of Anesthesiologists, scheduled to undergo elective transurethral resection of prostate, were randomly allocated to receive either hyperbaric ropivacaine 0.75% 2.8 mL plus fentanyl 15 mcg or hyperbaric bupivacaine 0.5% 2.8 mL plus fentanyl 15 mcg. The parameters, such as demographic characteristics, duration of surgery, onset of sensory and motor blockade, hemodynamic stability, and complications, were compared in both groups. Results: Hyperbaric ropivacaine exhibited significantly slower onset times for sensory and motor blockade compared to hyperbaric bupivacaine. Patients in the ropivacaine group demonstrated better hemodynamic stability and experienced less hypotension compared to those who received bupivacaine. Moreover, the sensory and motor block lasted significantly longer in the bupivacaine group. Conclusion: About 0.75% hyperbaric ropivacaine is a better choice for spinal anesthesia in elderly patients undergoing TURP as compared to 0.5% hyperbaric bupivacaine.

Ultrasound-assisted lumbar puncture with a horizontal and perpendicular paramedian approach based on positioning in patients with abnormal spinal anatomy: a case report and technical description

BackgroundThe use of ultrasound has been reported to be beneficial in challenging neuraxial procedures. The angled probe is responsible for the main limitations of previous ultrasound-assisted techniques. We developed a novel technique for challenging lumbar puncture, aiming to locate the needle entry point which allowed for a horizontal and perpendicular needle trajectory and thereby addressed the drawbacks of earlier ultrasound-assisted techniques.Case presentationPatient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen. The preprocedural ultrasound scan revealed a cephalad probe’s angulation (relative to the edge of the bed) in the paramedian sagittal oblique view, and then the probe was rotated 90° into a transverse plane and we noted that a rocking maneuver was required to obtain normalized views. Then the shoulders were moved forward to eliminate the need for cephalad angulation of the probe. The degree of rocking was translated to a lateral offset from the midline of the spine through an imaginary lumbar puncture’s triangle model, and a needle entry point was marked. The spinal needle was advanced through this marking-point without craniocaudal and lateromedial angulation, and first-pass success was achieved in all eight lumbar punctures. Patient 2 was an elderly patient with ankylosing spondylitis who underwent spinal anesthesia for transurethral resection of the prostate. The patient was positioned anteriorly obliquely to create a vertebral rotation that eliminated medial angulation in the paramedian approach. The procedure succeeded on the first pass.ConclusionsThis ultrasound-assisted paramedian approach with a horizontal and perpendicular needle trajectory may be a promising technique that can help circumvent challenging anatomy. Larger case series and prospective studies are warranted to define its superiority to alternative approaches of lumbar puncture for patients with difficulties.

Outcome of Low-Dose 0.5% Levobupivacaine (Plain) And Low-Dose 0.5% Bupivacaine (Heavy) Combined with Fentanyl in Spinal Anaesthesia For Transurethral Resection of Prostate: A Comparative Study

Background: Spinal anaesthesia is widely used for transurethral resections of prostate (TURP) because it allows early recognition of symptoms caused by over hydration, TURP syndrome, and bladder perforation. Patients undergoing TURP surgery have coexisting pulmonary or cardiac disease. Objective: To evaluate the outcome of the two anaesthetic agents – levobupivacaine and bupivacaine in TURP surgery when they are combined with fentanyl. Method: Total eighty patients were selected by inclusion and exclusion criteria, and then the selected patients were randomly divided into 2 groups (40 in each). levobupivacaine group (1) was received intrathecal 0.5% levobupivacaine 5mg (1 ml) + 25 micro gram fentanyl (0.5ml) and in bupivacaine group (2) was received intrathecal 0.5% bupivacaine heavy 5 mg(1ml) +25 micro gram fentanyl(0.5ml) slowly @1ml/10sec. Heart rate, noninvasive systolic, diastolic and mean arterial blood pressures and oxygen saturation (SpO2) were recorded immediately before intrathecal injection and every 3 min for 15 min after intrathecal injection and there after every 5 minutes upto 40 minutes and at the end of surgery. Results: All the haemodynamic variables except heart rate were almost statistically matched. Half of levobupivacaine group and 30% of the bupivacaine group achieved a sensory block up to the level of T10. Sixty percent of the levobupivacaine and 15% of the bupivacaine group at the beginning of the surgery had modified Bromage score ‘1’. None of the levobuppivacaine and 15% of the bupivacaine groups had a Bromage score ’3’. The recovery from motor block was significantly earlier in the levobupivacaine group compared to that in the bupivacaine group. Over half (55%) of the former group exhibited complete recovery at the end of surgery as opposed to only 20% of the latter group. Conclusion: For TURP surgery, a low dose of levobupivacaine with fentanyl can provide an adequate sensory blockade and can be used as a good alternative to bupivacaine. Sir Salimullah Med Coll J 2022; 30: 115-122

Unexpected systolic anterior motion of the mitral valve-related hypoxemia during transurethral resection of the prostate under spinal anesthesia: a case report

BackgroundDynamic obstruction of the left ventricular outflow tract resulting from systolic anterior motion of the mitral valve can be an unexpected cause of acute and severe perioperative hypotension in noncardiac surgery. We report a patient undergoing spinal anesthesia for transurethral resection of the prostate who experienced sudden hypoxemia caused by systolic anterior motion-induced mitral regurgitation but with a clinically picture simulating fluid overload.Case presentationAn 83-year-old man with a history of hypertension was scheduled for transurethral resection of the prostate. One hour after spinal anesthesia, he developed acute restlessness and dyspnea, with pink frothy sputum and progressive hypoxemia. Slight hypertension was noted, and an electrocardiogram showed atrial fibrillation with a rapid ventricular response. Furosemide and nitroglycerin were thus administered for suspected fluid overload or transurethral resection of the prostate syndrome; however, he then became severely hypotensive. After tracheal intubation, intraoperative transesophageal echocardiography was promptly performed, which revealed an empty hypercontractile left ventricle, significant mitral regurgitation and mosaic flow signal in the left ventricular outflow tract. Following aggressive fluid therapy, his hemodynamic changes stabilized. Repeat echocardiography in intensive care unit confirmed the presence of systolic anterior motion of the anterior mitral leaflet obstructing the left ventricular outflow tract. We speculate that pulmonary edema was induced by systolic anterior motion-associated mitral regurgitation and rapid atrial fibrillation, and the initial management had worsened his hypovolemia and provoked left ventricular outflow tract obstruction and hemodynamic instability.ConclusionsPulmonary edema caused by systolic anterior motion of the mitral valve can be difficult to clinically differentiate from that induced by fluid overload. Therefore, bedside echocardiography is paramount for timely diagnosis and prompt initiation of appropriate therapy in the perioperative care setting.

Dural sac cross-sectional area measured using ultrasound to modify the dosage of local anaesthetic in spinal anaesthesia for transurethral resection of prostate surgery: A prospective, double blind, randomised controlled study.

The area of lumbar spinal canal decreases with age, and hence the level of sensory blockade is higher in the elderly after spinal injection. The present study optimised the dose of local anaesthetic in elderly patients based on the lumbar dural sac cross sectional area (DSCSA) determined using ultrasound. Sixty patients of age above 60 years undergoing transurethral resection of prostrate (TURP) surgery in a tertiary care hospital were included in the study. Patients were categorised into two groups of 30 each based on a computer-generated random number table. In the control group (C), 2 ml of 0.5% hyperbaric bupivacaine was given and in the ultrasound group (U), the drug dose was modified according to DSCSA which was measured using the formula area = p (diameter/2) 2. The DSCSA and bupivacaine dosage were significantly lower in group U compared to control group (P = 0.0001). The maximal level of cephalad spread of sensory blockade was significantly lower in ultrasound group, than in control group (P = 0.002). The two-segment block regression time and motor recovery time was less in group U. Higher mean arterial pressure (105.8 ± 9.66 mmHg; P = 0.007), and a lower decrease from baseline (14.15 ± 7.55%; P = 0.041) was noted in group U after subarachnoid block. The estimation of DSCSA is an effective parameter and can be used to modify the dose of local anaesthetic for subarachnoid block in elderly patients undergoing TURP surgery.

A COMPARATIVE STUDY BETWEEN CLASSIC AND INTERADDUCTOR APPROACH OF OBTURATOR NERVE BLOCK WITH ROPIVACAINE IN PATIENTS UNDERGOING TRANSURETHRAL RESECTION OF BLADDER TUMOUR UNDER SPINAL ANAESTHESIA.

Background: The most signicant use of ONB i.e., obturator nerve block is to prevent adductor muscle contraction associated with Transurethral resection of bladder tumours (TURBT). Adductor jerk during TURBT may cause serious injury to urinary bladder like laceration with involvement of blood vessels, severe bleeding, bladder wall tear and perforation and even partial resection of bladder tumour due to frequent distraction and interruption to the surgeon.1 So, there is need for evaluation and comparison of different techniques of ONB in view of safety and efcacy. We have conducted a randomized clinical study to compare the classic pubic and inter adductor approach for ONB with spinal anaesthesia for transurethral resection of bladder wall tumour masses. Method: A total number of 50 patients of either sex of ASA physical status I or II, of age group 30-75 years, who were posted for TURBT operation under spinal anaesthesia, were included in this study. A Prospective single blind randomised controlled trial and cross over study was conducted. Peripheral nerve stimulator to localize the nerve and Inj. Ropivacaine 0.5% ,15 ml on each side was used in this study. Result: The overall success rate in classic pubic approach was slightly lower than interadductor approach which was statistically insignicant. There were more instances of vessel puncture in pubic approach, which was statistically signicant (p value = 0.016). There was no incidence of other signicant complications. Conclusion: In terms of ease of obturator nerve block and incidence of complications the interadductor approach is better than classic pubic approach.

Outcome of Obturator Nerve Block by Inguinal and Transvesical Approach in Transurethral Resection of Bladder Tumor

Introduction and aim of the study : Spinal anaesthesia for transurethral resection of bladder tumor (TURBT) does not prevent unintended stimulation of the obturator nerve when electro resection is performed on the lateral and Postero-lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to compare the outcome of obturator nerve block by inguinal and transvesical approach.
 Materials and Methods: A prospective experimental study was done in the department of Urology Dhaka Medical College Hospital during the period of November 2016 to April 2018. Total 60 Patients were included for the study as per inclusion and exclusion Criteria. Patients were than allocated purposively into two groups by simple random sampling. Group A consisted of 30 patients where obturator nerve block (ONB) was done by transvesical approach and Group B also consisted of 30 patients where ONB was done by inguinal approach.
 Results: In the present study, the baseline characteristics of the patients in Group-A and Group-B were almost similar having no statistically significant difference. Obturator jerk more frequently occurred in group-B, in 13 (56.37%) patients following TURBT compared to Group-A, where 05(16.67%) patients developed obturator jerk. The intergroup difference was statistically significant (p<0.05). In case of 26 (86.67%) patients tumour was completely resectable in group-A, while in 21 (70.00%) patients of Group- B tumour was completely resectable. This was not a statistically significant difference (P>0.05). There was no incidence of bladder wall perforation in group-A, wherears this complication occurred in 02 (06.67%) cases of Group-B (p>0.05). Mean operative time in Group-A and group-B is 50.46 (±11.64) and 59.10 (±15.83) respectively (p<0.05).
 Conclusion: We conclude that transvesical approach is better in case of Jerk elimination and Less Procedure related time than inguinal approach during TURBT
 Bangladesh Journal of Urology, Vol. 23, No. 2, July 2020 p.118-123

Comparison the Effects of Oral Tizanidine and Tramadol on Intra- and Post-operative Shivering in Patients Underwent Spinal Anesthesia.

Background:Heat loss and core-to-peripheral redistribution of body heat occur in patients undergoing neuraxial anesthesia resulted to decrease of core temperature and early reach of shivering threshold. Because shivering has deleterious metabolic and cardiovascular effects, it should ideally be prevented by pharmacologic or other means. Tizanidine is an alpha-2 agonist. We evaluated the usefulness of oral tizanidine (TI) and tramadol in preventing of shivering in patients undergoing spinal anesthesia for transurethral resection of the prostate (TURP).Materials and Methods:Ninety patients, scheduled for TURP with spinal anesthesia, were prospectively enrolled. Patients were randomly assigned to 1 of 3 groups. 90 min before spinal anesthesia, 30 patients received 4 mg oral TI, 30 patients received 50 mg tramadol, and 30 patients received placebo as control group. Spinal anesthesia was induced at the L3–L4 or L4–L5 interspaces with 12.5 mg bupivacaine. An investigator blinded to the drugs recorded the frequency and degree of shivering.Results:The overall frequency and severity of shivering were significantly lower in patients treated with TI and tramadol compared to placebo (P = 0.04) (P = 0.001). There was not much difference in the nausea and vomiting of both the drugs (P = 026) (P = 011). There was no difference in hemodynamic parameters between three groups (P = 0.08) (P = 013).Conclusions:Oral TI and tramadol were comparable in respect to their effect in decreasing the incidence, intensity shivering when used prophylactically in patients who underwent TURP with spinal anesthesia.

Different low doses of levobupivacaine 0.5% with nalbuphine in spinal anesthesia for transurethral resection of prostate surgery

Background Subarachnoid block is a widely used technique for transurethral resection of the prostate (TURP) surgery in elderly, especially in those with respiratory and cardiac problems.Aim The aim of this study was to evaluate the efficacy of different low doses of levobupivacaine 0.5% when they are combined with nalbuphine in spinal anesthesia for TURP surgery, their efficiency for postoperative analgesia, and its side effects.Patients and methods A total of 90 patients older than 60 years of age and American Society of Anesthesiologists physical status I–III who underwent TURP under spinal anesthesia were enrolled. Patients were randomly divided into two groups: group I received intrathecal injection of 5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 1 ml normal saline as total volume of 3 ml and group II received intrathecal injection of 7.5 mg levobupivacaine 0.5% and 1 mg nalbuphine in 0.5 ml normal saline as total volume of 3 ml. Patients were assessed for sensory and motor block characteristics, postoperative visual analog pain scale, and side effects.Results Patients in group II had earlier onset of sensory block at T10, longer duration of sensory and motor block and two-segment regression times, higher level of maximum sensory block, higher Bromage score at the end of surgery, and lower visual analog pain scale in the early postoperative period.Conclusion Levobupivacaine 0.5% of 5 and 7.5 mg with the addition of 1 mg nalbuphine are considered to be convenient for clinical use in TURP surgery with spinal anesthesia. Levobupivacaine of 7.5 mg had a better sensory block quality and prolonged early postoperative analgesia with similar hemodynamic stability without increasing complications.

Spinal Anesthesia for Transurethral Resection of Prostate: Levobupivacaine with or without Fentanyl

Background: The aim of the present study was to compare the characteristics of spinal blocks produced by low dose levobupivacaine (0.5%) and compare it when combined with fentanyl in transurethral resection of prostate. Methods: With Institutional ethical committee clearance a prospective, randomized, double-blinded study conducted. After obtaining informed written consent a total of 140 patients scheduled for elective TURP were randomly allocated into one of the two groups of 70 patients each. Following a spinal tap, patients in Levobupivacaine Group(L) received 1.5 ml of 0.5% isobaric levobupivacaine and in Levobupivacaine - Fentanyl Group (LF) received 1 ml of 0.5% isobaric levobupivacaine with fentanyl 25 μg (0.5 ml) intrathecally. The characteristics of sensory and motor block, hemodynamic data, side effects, patient and surgeon satisfaction were recorded. Results: There were no significant differences between the two groups for patient demographic, intraoperative hemodynamic parameters, side effects and satisfaction. The highest level of sensory block was T9 in the Group L, and T8 in the Group LF (p = 0.001). Duration of motor block was shorter in Group LF than in Group L (154.76 ± 16.39 minutes in Group L; 136.23 ± 9.06 minutes in Group LF) (p = 0.001). Conclusion: Both regimes are effective, and the addition of fentanyl to levobupivacaine may offers prolong duration of sensory block and postoperative analgesia and the advantage of shorter duration of motor block, thus it may be used as an alternative to pure levobupivacaine solution in spinal anaesthesia, for transurethral resections.

Satisfactory spinal anesthesia with a total of 1.5mg of bupivacaine for transurethral resection of bladder tumor in an elderly patient.

Spinal anesthesia is popular for endoscopic urological surgery. Many patients undergoing urological surgery are elderly. It is important to limit the dose to reduce any resultant hemodynamic effect. We present a case in which incremental administration of 0.1 % bupivacaine up to 1.5 mg was sufficient to produce satisfactory spinal anesthesia for transurethral resection of bladder tumor (TURBT).

Effect of Preemptive Flurbiprofen Axetil and Tramadol on Transurethral Resection of the Prostate under Spinal Anesthesia.

Objective. To investigate the efficacy of preoperative intravenous flurbiprofen axetil and tramadol on spinal anesthesia for transurethral resection of the prostate (TURP). Methodology. In this prospective clinical study, we enrolled 60 patients undergoing TURP under spinal anesthesia with small-dose bupivacaine and sufentanil. Patients were randomly divided in two: group flurbiprofen axetil and tramadol (Group FT) intravenously received 1 mg/kg flurbiprofen axetil and 1 mg/kg tramadol 20 min prior to the surgical procedures and group control (Group C) was given normal saline. The characteristics of spinal anesthesia, blood pressure, heart rate, analgesic requirement, visual analogue scale (VAS), and overall satisfaction degree were collected. Results. Time to the first analgesic requirement was significantly longer in Group FT. Patients who needed postoperative analgesics were fewer in Group FT. VAS scores were lower in Group FT at postoperative time points of 1, 2, 6, and 12 h. The patients in Group FT were more satisfied than in Group C. Conclusions. Preoperative flurbiprofen axetil and tramadol can reduce and delay postoperative pain and then decrease analgesic consumption for TURP under spinal anesthesia without an increase of side effects.

English

BACKGROUND: Spinal anesthesia for transurethral resection of the prostate (TURP) leads to high incidence of arterial hypotension. We hypothesized that the reduction of this dose from 15 mg to 7.5 mg without much change in baricity would minimize hypotension without altering anesthetic benefits. METHODS: 60 ASA-1 & ASA-2 patients scheduled for TURP were randomized into two groups A and B receiving 7.5 and 15 mg of hyperbaric bupivacaine both with 90 μg of buprenorphine respectively in spinal anesthesia. Intravenous ephedrine was administered for each episode of hypotension. We recorded sensory and motor block, intra operative vitals, pain, nausea and vomiting. RESULTS: Duration of analgesia found statistically significantly high in group B as compared to group A (421.6±35.6 vs. 133.8±27.4 min respectively, p=<0.0001) Also, use of ephedrine as a vasopressor was more in group B patients (36.6%) as compared to group A patients(10%) and was statistically significant(p=0.03). CONCLUSION: A dose of 7.5 mg of hyperbaric bupivacaine reduced incidence of hypotension without altering pain relief.

The comparison of levobupivacaine in continuous or single dose spinal anesthesia for transurethral resection of prostate surgery

BackgroundThe aim of the study is to compare the efficacy of levobupivacaine induced continuous spinal anesthesia (CSA) versus single dose spinal anesthesia (SDSA) in patients who are planned to undergo transurethral prostate resection. MethodsSixty years or older, ASA I–II or III, 50 patients were included in the study. 12.5mg 0.5% levobupivacaine were administered intrathecally in SDSA group. In CSA group, initially 2mL of 0.25% levobupivacaine were administered through spinal catheter. In order to achieve sensory block level at T10 dermatome, additional 1mL of 0.25% levobupivacaine were administered through the catheter in every 10min. Hemodynamic parameters and block characteristics were recorded. Preoperative and postoperative blood samples of the patients were drawn to determine plasma cortisone and plasma epinephrine levels. ResultsCSA technique provided better hemodynamic stability compared to SDSA technique particularly 90min after intrathecal administration. The rise in sensory block level was rapid and the time to reach surgical anesthesia was shorter in SDSA group. Motor block developed faster in SDSA group. In CSA group, similar anesthesia level was achieved by using lower levobupivacaine dose and which was related to faster recovery. Although, both techniques were effective in preventing surgical stress respond, postoperative cortisone levels were suppressed more in SDSA group. ConclusionCSA technique with 0.25% levobupivacaine can be used as a regional anesthesia method for elderly patients planned to have TUR-P operation.

Over 500 obturator nerve blocks in the lithotomy position during transurethral resection of bladder tumor

Introduction and aim of the studySpinal anesthesia for transurethral resection of bladder tumor (TURB) does not prevent unintended stimulation of the obturator nerve when electroresection is performed on the lateral wall of the bladder. It results in muscle contraction of the adductor muscles of the thigh, which may lead to perforation of bladder wall with the resectoscope loop. The aim of the study was to assess the efficacy and safety of obturator nerve block (ONB).MethodsThis prospective study was conducted between 01/01/1999 and 12/31/2010 in the Department of General, Oncologic and Functional Urology, Medical University of Warsaw. In 431 patients undergoing TURB adductor spasms were observed. In these cases nerve stimulation and ONB with 2% lidocaine using thigh interadductor approach in the lithotomy position were performed.ResultsThe efficacy of 542 ONB was 94%. In 31 cases general anesthesia was necessary. There were two cases of urinary bladder perforation, but only one resulted from an insufficient nerve block. Both were managed conservatively. Neither hematomas nor neurological adverse events were observed.ConclusionThe described method offers a high rate of efficacy and ensures optimal and safe conditions for the resection of a tumor located on the inferolateral wall of the urinary bladder. The risk of complication is low.

The Effects of Low Dose Levobupivacaine with or without Sufentanil Intrathecally in Transurethral Resection of Prostate

Aim: We aimed to compare the clinical efficacy of levobupivacaine alone and levobupivacaine/sufentanil combination in spinal anesthesia for transurethral resection of the prostate (TURP) in elderly patients. Method: Ninety patients were randomly assigned into two groups to receive either levobupivacaine 10 mg (Group L) or levobupivacaine 7.5 mg combined with 2.5 μg sufentanil (Group LS) for spinal anesthesia. The dermatome level and upper level of sensory blockade, time to develop a sensory block to T10, duration of sensory and motor blockade, Bromage score at the end of surgery, two- segment sensory regression time, and side effects were recorded. The quality of anesthesia was evaluated and rated after the surgery. Result: There were no significant differences between groups in demographic data or hemodynamic variables in terms of sensory blockade, onset time of sensory blockade to T10 dermatome, and two-segment regression. Bromage score at the end of surgery was significantly higher in Group L (p<0.05). The number of patients with maximum motor block was significantly higher in Group L (p<0.05). Complete motor block resolution time was longer in Group L (p<0.05). There were no significant differences in side effects between groups except for pruritus (p<0.05). There were no significant differences between groups in quality of anesthesia. Conclusion: It was shown that 10 mg levobupivacaine and 7.5 mg levobupivacaine combined with 2.5 μg sufentanil were considered to be convenient for clinical use in TURP surgery with spinal anesthesia; both treatments provided adequate anesthesia with hemodynamic stability in elderly patients.

Intrathecal meperidine for prevention of shivering during transurethral resection of prostate.

The aim of this study was to investigate low-dose intrathecal meperidine for prevention or alleviation of shivering after induction of spinal anesthesia for transurethral resection of the prostate (TURP). In a randomized controlled trial, 80 patients scheduled for TURP under spinal anesthesia were assigned into two groups of case and control. Spinal anesthesia was performed using 75 mg of hyperbaric lidocaine 5% plus meperidine, 15 mg, in the patients of the case group and the same dose of lidocaine plus normal saline in the patients of the control group. Shivering episodes were recorded during the operation and in the recovery room. Data on systolic blood pressure, heart rate, arterial oxygen saturation, and body temperature were collected before the induction of anesthesia; 5, 15, and 30 minutes after the induction; and in the recovery room. Maximum level of sensory block was similar in the patients of the case and control groups. Shivering was not seen in the patients who received meperidine, while in the control group, 11 (27.5%) experienced some degrees of shivering (P = .001). Blood pressure, body temperature, and arterial oxygen saturation did not have a clinically significant change and they were not different between the two groups. Side effects of opioids were unremarkable. Low-dose intrathecal meperidine is effective and safe in reducing the incidence of shivering associated with spinal anesthesia for TURP.

Anesthetic Management of the Patient with Persistent Penile Erection Developed after Spinal Anesthesia: A case report

A 50-year-old man with bladder cancer had spinal anesthesia for transurethral resection of bladder. After he had spinal block at the level, he developed a persistent penile erection, making it impossible to introduce the 24 French cystoscope. To treat a persistent penile erection, intravenous glycopyrrolate was incrementally given for a total of 0.4 mg. A persistent penile erection was markedly subsided 5 minutes after last 0.2 mg glycopyrrolate was given. Then corpus cavernosum blood was aspirated. The cystoscope was easily introduced, and transurethral resection of bladder proceeded without further complication.

Spondylodiscite après rachianesthésie pour résection transurétrale de prostate

We described a case of discitis and meningitis following spinal anaesthesia for transurethral resection of the prostate. The patient received antibiotics for a month before surgery, because of Klebsiella prostatitis. Spinal anaesthesia was performed in L3-L4 interspace by using 22G Quincke needle. Bacteriaemia occurred during the first postoperative hours. Ten days after spinal anaesthesia, patient suffered from lumbar pain, exacerbated by vertebral percussion, and motor weakness within lower limb, which was marked on right side. MRI examination showed L3-L4 discitis with psoas abcess in regard, and epiduritis marked around L3 right spinal root. CSF examination confirmed meningitis but no bacteria was found. Antibiotics were administered over a 6 weeks period, and then patient discharged from hospital without neurological sequellae. Infectious discitis related to disk puncture during spinal anaesthesia and postoperative bacteriaemia was likely in our patient.

Repeated Relapses in a Meropenem-Treated Pseudomonas aeruginosa Meningitis

Infectious complications of spinal or epidural anesthesia are rare. Meningitis is the well known form of this complication. We report here a case of recurrent relapses of meningitis due to Pseudomonas aeruginosa following spinal anesthesia for transurethral resection in a 65-year-old diabetic patient, hospitalized in our clinic due to meningitis, which had developed 8 days fol lowing spinal anesthesia for a transurethral resection in a state hospital. Because CSF examination was suggestive of bacterial meningitis, ceftazidime 2 g t.i.d. and vancomycin 500 mg f.i.d. were initially given to the patient. The day after hospitalization P. aeruginosa was cultured from CSF, blood and urine cultures. The isolates were identical for antibiotic susceptibility and were susceptible to meropenem and ceftazidime according to the disc diffusion test (no MICs were available for the original isolate). Then vancomycin was stopped and ceftazidime treatment was continued. There was no decrease in fever and no change in clinical signs, so ceftazidime treatment was changed to meropenem monotherapy on day 7 of the treatment. Clinical and laboratory response was obtained on the 21st day of disease onset and then treatment was stopped and he was discharged. Journal of Chemotherapy Vol. 14 n. 5 (535-536) 2002