Comparison of epidural, spinal, and saddle block for holmium laser enucleation of prostate (HoLEP)

Abstract

Background: Holmium laser enucleation of the prostate (HoLEP) has become an important treatment modality for benign prostate hypertrophy. The aim of the present study was to compare regional anesthesia methods for HoLEP operation and to determine the optimal technique. Methods: Sixty patients with American Society of Anesthesiologists scores of I-III were randomly allocated into 3 groups. Patients in group E received an epidural block with 75 mg of bupivacaine plus 50 μg of fentanyl. In group S, 15 mg of bupivacaine and 50 μg fentanyl were used for spinal anesthesia. In group SA, patients received saddle block with 15 mg of bupivacaine and 50 μg of fentanyl. Results: Time to T10 dermatome block and to maximal level block were longest in group E ( P < .05), and maximal sensorial block level was higher in group E than group SA ( P < .05). There was a significant difference in postoperative motor block, but no difference in systolic blood pressure and heart rate. Conclusion: Among 3 techniques, saddle block might be preferable in HoLEP because an adequate sensorial level was achieved with lower motor block and stable hemodynamics.

Hemodynamic Comparison between modified saddle block and subarachnoid block for Transurethral Resection of Prostate

“…This shows that modified saddle block is even more hemodynamically stable than standard saddle block and is as effective as SAB for providing adequate regional analgesia for TURP. Similarly comparison with other studies shows that modified saddle block provides better hemodynamics as compared to SAB and standard saddle block [7][8][9][10] . Similarly patients receiving saddle block was found to have better hemodynamic profile as compared to SAB or epidural, while undergoing HoLEP 10 .…”

“…Similarly comparison with other studies shows that modified saddle block provides better hemodynamics as compared to SAB and standard saddle block [7][8][9][10] . Similarly patients receiving saddle block was found to have better hemodynamic profile as compared to SAB or epidural, while undergoing HoLEP 10 .…”

Comparison of Arterial Pressure and Vasopressor (Phenylephrine) Among Patients Undergoing Turp With Spinal Anesthesia Versus Saddle Block

“…Physicians use various methods of anesthesia to prepare the students for surgery (Jiang and Qian, 2019;Parsons et al, 2020). The conventional mode is spinal anesthesia, but as patients are put in a lithotomy position for surgery, there is a risk of vasodilatation because of the sympathetic blockade that results in diminished venous return and subsequently causes hypotension (Kim et al, 2021). This problem can be overcome using vasopressors and IV fluids, but even access to these may be dangerous for elderly patients with compromised cardio-pulmonary health (Sivasankari, 2020).…”