Comparison of intrathecal fentanyl and buprenorphine in urological surgery.

OBJECTIVE To evaluate and compare the characteristics of spinal block, its postoperative analgesic effects and side effects using intrathecal bupivacaine and its combination with fentanyl or buprenorphine in elderly patients undergoing urological surgery. METHODS Sixty patients aged sixty and above scheduled for elective transurethral resection of prostate (TURP) randomly received hyperbaric bupivacaine 0.75% 2 ml (group L control, n = 20), buprenorphine 30 micrograms [DOSAGE ERROR CORRECTED] with hyperbaric bupivacaine 0.75% 2 ml (group B, n = 20) or fentanyl 10 micrograms [DOSAGE ERROR CORRECTED] with hyperbaric bupivacaine 0.75% 2 ml(group F, n = 20). Characteristics of spinal block, haemodynamic stability, postoperative analgesia and incidence of adverse effects were compared. All patients were followed for twenty four hours. RESULTS The patients' blood pressures remained within 20% of baseline values. The mean time for the sensory block to reach T10 dermatomal level was 3.2 +/- 2 minutes in fentanyl-bupivacaine group versus 4.3 +/- 1 in buprenorphine-bupivacaine and 4.5 +/- 2 bupivacaine alone group. The duration of sensory block was significantly longer in buprenorphine-bupivacaine group. Median block levels reached T8 in all groups. All patients required postoperative analgesia in group L and F except 6 in buprenorphine group. CONCLUSION Buprenorphine 30g in combination with bupivacaine 0.75% 2 ml provided analgesia of comparable clinical onset and longer duration but was associated with a clinically increased incidence of nausea and vomiting in elderly patients.