A Randomised Double-Blind Clinical Trial Comparing Isobaric Ropivacaine 0.5% With Dexamethasone and 0.75% Ropivacaine Alone in Spinal Anaesthesia in Transurethral Resection of Prostate Cases

Abstract

BACKGROUNDThis clinical study was designed to evaluate the clinical efficacy and safety of lower concentration of ropivacaine i.e. intrathecal 0.5% isobaric ropivacaine with dexamethasone for transurethral resection of prostate (TURP) in elderly patients. This combination should provide better haemodynamic stability and prolonged postoperative analgesia compared with 0.75% plain ropivacaine. MATERIALS AND METHODSEighty patients were randomly divided into two groups, each comprising of 40 patients. Subarachnoid block was performed using 3.5 mL isobaric Ropivacaine 0.5% with 1 mL Dexamethasone (4 mg) in group I (RD) and 3.5 mL isobaric Ropivacaine 0.75% with 1 mL normal saline in group II (R). Haemodynamic parameters, onset and total duration of sensory and motor block, time to reach maximum sensory block, duration of sensory and motor block at T10, postoperative analgesic requirements and adverse effects were recorded. RESULTSGroup RD shows longer onset of sensory blockade was 2.30 ± 0.56 minutes compared to 1.58 ± 0.64 minutes in group-R (P< 0.001) and motor blockade 2.23 ± 0.70 minutes compared to 1.68 ± 0.694 minutes in group-R (P<=0.001). The median time to reach the highest level of analgesia was 19.05 ± 6.02 minutes in group RD; 16.05 ± 4.68 in group R. The duration of sensory level at T10 dermatome was prolonged i.e. 90.60 ± 38.90 minutes in group-R compared to 47.45 ± 13.81 minutes in group-RD (P<0.001). Total duration of sensory block was prolonged in group R i.e. 188.75 ± 20.68 compared to 155.38 ± 28.10 in group RD (P<0.001). The duration of motor blockade in group-RD was 118.00 ± 13.24 minutes compared to 154.75±20.88 minutes in group-R (P<0.001). The time of first request of analgesics in group-RD was 293.08 ± 28.26 minutes compared to 267.95 ± 30.52 minutes in group-R (P = 0.000). The total opioid consumption within 24 hours following surgery in group-I was 77.50 ± 31.92 milligrams compared to 102.50 ± 35.72 milligrams in group-R (P<0.001). CONCLUSIONRopivacaine 0.5% with dexamethasone produces adequate surgical anaesthesia for TURP surgeries with negligible haemodynamic disturbances and prolongs the time to first request for analgesia and lesser opioid consumption following surgery. Submission 15-04-2017, Peer Review 19-06-2017, Acceptance 23-06-2017, Published 09-10-2017 Karad. E-mail: dhanashree_kale02@yahoo.com DOI: 10.14260/jemds/2017/1234 haemodynamic stability and low incidence of hypotension and bradycardia. 1 Ageing and disease make elderly patients susceptible to hypotension during anaesthesia as these patients have a relatively high prevalence of coexisting systemic diseases. Benign prostatic hypertrophy frequently leads to symptomatic bladder outlet obstruction in older men. Recent clinical data have shown that ropivacaine is clinically effective and safe for regional anaesthetic techniques with good tolerability. 2 Ropivacaine could provide adequate surgical anaesthesia without compromising early ambulation and discharge. 2 Corticosteroids have been studied recently as adj...