A randomized controlled trial comparing the recovery time after spinal anesthesia with 2% hyperbaric prilocaine 50 mg vs. 0.5% hyperbaric bupivacaine 12.5 mg for cystoscopic procedures

Abstract

Background: Cystoscopy is a urologic procedure performed as a diagnostic or a therapeutic intervention, usually requiring spinal anesthesia (SA). Bupivacaine is a frequently used spinal anesthesia agent. However, the prolonged duration of its effect is a disadvantage. Prilocaine may be an alternative for spinal anesthesia in cystoscopy, which has a shorter duration of action compared to bupivacaine. We compared recovery time of 2% hyperbaric prilocaine 50 mg vs. 0.5% hyperbaric bupivacaine 12.5 mg for cystoscopic procedures under spinal anesthesia.
 Methods: This study was a randomized controlled trial involving 66 patients who underwent cystoscopy in Dr. Cipto Mangunkusumo National General Hospital under SA. Subjects were randomized into two groups, i.e. prilocaine group to receive SA with hyperbaric prilocaine 2% 50 mg + fentanyl 25 µg and bupivacaine group to receive hyperbaric bupivacaine 0.5% 12.5 mg + fentanyl 25 µg. Following SA, the time to lift the leg 45 degrees and time to regain the ability to walking unsupported were noted in both groups and statistically compared. Hemodynamic changes in SpO2 and NIBP at fixed periods, as well as adverse effects were recorded.
 Results: Hemodynamic changes and adverse effects were comparable between the two groups. The mean time to lift a leg 45 degrees (93.88 min vs. 180.36 min; P < 0.001) and the time until the patient walked (144.91 min vs. 259.76 min; P < 0.002) were significantly short in the prilocaine group. The mean regression time for prilocaine and bupivacaine SA was 69.36 ± 35.85 and 131.88 ± 79.43 min respectively; the difference being significant (P < 0.001).
 Conclusion: Hyperbaric prilocaine 2% has a shorter recovery period when compared to hyperbaric bupivacaine 0.5% for spinal anesthesia and is appropriate for the length of the cystoscopy, making it a viable spinal anesthetic option.
 Keywords: Bupivacaine; Cystoscopy; Prilocaine; Anesthesia, Spinal; Recovery Time
 Citation: Tantri AR, Marbun JCRN, Heriwardito A. A randomized controlled trial comparing the recovery time after spinal anesthesia with 2% hyperbaric prilocaine 50 mg vs. 0.5% hyperbaric bupivacaine 12.5 mg for cystoscopic procedures. Anaesth. pain intensive care 2023;27(6):689−696; DOI: 10.35975/apic.v27i6.2145
 Received: January 29, 2023; Reviewed: October 23, 2023; Accepted: October 23, 2023