Comparison of Intrathecal Bupivacaine with Levobupivacaine using Fentanyl as an Adjuvant for Transurethral Resection of Prostate-A Randomised Controlled Trial

Introduction: Transurethral Resection of Prostate (TURP) is a common surgical procedure performed for Benign Prostatic Hypertrophy (BPH), most commonly under Spinal Anaesthesia (SA). It is generally tolerated well by the elderly but since they suffer from several co-morbidities, therefore, it is desirable to avoid hypotension following SA, in these patients. Levobupivacaine, a pure S enantiomer of racemic bupivacaine has emerged as a safe alternative to bupivacaine with similar efficacy and better pharmacokinetic profile.

Aim: To compare the efficacy of intrathecal levobupivacaine with bupivacaine using fentanyl as adjuvant in TURP.

Materials and Methods: This randomised controlled trial was conducted at Pandit BD Sharma Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, between March 2022 to September 2022. Fifty patients, 50-80 years of age, American Society of Anaesthesiologists (ASA) I-III, posted for TURP under SA, were included in the study and divided into two groups: group B (n=25): Inj. bupivacaine (0.5%) hyperbaric 12.5 mg+25 μg fentanyl citrate, group L (n=25): Inj. levobupivacaine (0.5%) isobaric 12.5 mg+25 μg fentanyl citrate. Onset of sensory and motor block, time to onset of maximum sensory and motor block, Heart Rate (HR), Systolic Bood Pressure (SBP), Diastolic Bood Pressure (DBP) and Mean Arterial Pressures (MAP) were recorded. Data analysis was done with the help computer software using Statistical Package for the Social Sciences (SPSS), version 24.0. Means, standard deviations, Chi-square, t-values and p-values were calculated, p-value <0.05 was considered significant at 95% confidence level.

Results: Demographic data of the patients was comparable. The mean time to onset of sensory block in group B was significantly faster (3.72±0.96 min) than group L (4.47±0.73 min). The mean time to onset of motor block was faster in group B (4.74±0.91 min) than group L (7.57±1.51 min). HR was lower in group B, after SA at 5, 10, 15, 20, 30, and 45 min after SA. Group B recorded a lower SBP, DBP and MAP following SA, compared to group L (p<0.001). The duration of analgesia was significantly longer in group B (232.80±14.07 min vs 221.80±15.47 min in group L) (p<0.05). No adverse effects were reported from either of the groups.

Conclusion: Levobupivacaine provided very stable haemodynamics, good quality analgesia and muscle relaxation intraoperatively. Postoperative analgesia was clinically similar to bupivacaine, no adverse effects were reported. Thus, levobupivacaine is a safe and reliable alternative to bupivacaine for elderly patients undergoing TURP.