Spinal Ropivacaine in fast-track TURP

Background: The addition of fentanyl to spinal ropivacaine anaesthesia has been shown to improve the quality of block, increase duration of sensory block, and provide postoperative analgesia without affecting motor function. In a randomized controlled, double blind study, we examined the efficacy and the adverse effects of three different regimen of spinal anesthesia. Methods: Forty-five patients scheduled for transuretheral resection of the prostate (TURP) under sudarachnoid anesthesia. Patients were randomly assigned to Group I (G I) hyperbaric bupivacaine 10 mg, Group II (G II) 15 mg heavy ropivacaine, and Group III (G III) ropivacaine 10 mg with 20 μg fentanyl. Evaluation of the block and side effects were performed after spinal anaesthesia. Results: Three patients in bupivacaine group, three patients in ropivacaine group and one patient in fentanyl group required sedative / analgesic supplementations. Patients of fentanyl group showed significant prolonged sensory block and significant decrease in the motor block. Time to walk was significantly shortened in fentanyl group, it was 150 min versus 197 and 162 min in bupivacaine and ropivacaine groups respectively. The visual analogue score for pain at 3, 6 and 12 hours after intrathecal anaesthesia in G II and III were significantly less than G I. No patient experienced respiratory depression, hypoxemia, hypotension or bradycardia during the postoperative period. Pruritus was reported in 12 patients (80%) of fentanyl group, but it was mild and did not necessitate medical treatment. Shivering was significantly less in the patients of fentanyl group. Conclusion: Intrathecal ropivacaine 10 mg plus 20 ug fentanyl resulted in sufficient analgesia comparable to 15 mg ropivacaine or 10 mg bupivacaine with better analgesia and discharge criteria for fast-track TURP.