Comparison of two different doses of hyperbaric bupivacaine with fentanyl for spinal anaesthesia in elderly patients undergoing routine endoscopic urological surgery: A randomized controlled study

The major drawback of spinal anesthesia in elderly patients is the per operative hypotension and its sequel . We compared two doses (7.5 mg or 10 mg) of hyperbaric bupivacaine 0.5% with 25µg fentanyl in 150 elderly patients undergoing routine urological surgery with respect to hemodynamic profile .Results: The time to onset of sensory block (min) was comparable amongst the two groups ( 2.41±0.86 and 2.25±0.79) in group A and B respectively .The mean time to regression of block to S2 level was at 3.56±0.53 hrs. in group A and 4.01±0.71 hrs in group B(p<0.0001). The maximum mean height of sensory block was at T8 level in 73.3% patients and T10 level in 18.6% patients of group A .In group B patients 58.6% had the sensory level at T6 level , in 33% patients it was at T8 and in 8% it was at T4 level .(p<0.0001). Onset of motor block was earlier in group B and was at 3.89±0.8 min over 4.23±1.01in group A. (p=0.026).The time to regression of motor block was earlier in group A ( 4.07±o.54 hrs over 4.69±0.58 hrs in group B).(p<0.0001) The decrease in MAP from baseline values was more in group B over group A (0% vs. 4.7%;p<0.05)) but the incidence of hypotension and bradycardia were statistically comparable amongst the groups .(p>0.05)Conclusion :The use of 7.5mg bupivacaine with 25 µg fentanyl intrathecally results in adequate anaesthesia and analgesia coupled with stable hemodynamic as required for transurethral surgery of around 2 hrs.duration .