Ropivacaine: Anesthetic consideration in elderly patients for transurethral resection of prostrate a clinical trial

Abstract

Background:Ropivacaine has less systemic toxicity and greater differentiation of sensory and motor blockade after subarachnoid block. This study was aimed to evaluate the anesthetic efficacy of intrathecal 0.75% isobaric ropivacaine alone or with fentanyl in elderly patients undergoing transurethral resection of prostrate.Materials and Methods:Fifty four elderly consented patients of ASA grade I-III scheduled for transurethral resection of prostrate under the subarachnoid block were randomized to receive either intrathecal 4 mL of 0.75% isobaric ropivacaine (Group R, n = 27) or 3.5 mL of 0.75% isobaric ropivacaine with 0.5 mL (25 μg) of fentanyl (Group RF, n = 27). The characteristics of sensory and motor blockade, intraoperative hemodynamic changes, and secondary effects were noted for evaluation.Results:There was no significant difference in the demographic profile of patients. The surgical anesthesia was adequate for TURP surgery in all patients. The median time to achieve the sensory blockade at T10 dermatome was 3.2 ± 1.5 min in Group R and 3.5 ± 1.3 min in Group RF. The median duration of sensory blockade at T10 was 130.6 ± 10.2 min in Group R and 175.8 ± 8.6 min in Group RF. The median duration of complete motor block was significantly shorter than the duration of sensory blockade (P < 0.001). There were fewer episodes of manageable hypotension in 5 patients of Group R and 11 patients of Group RF. No secondary effects have occurred in any patients.Conclusion:The intrathecal 0.75% isobaric ropivacaine alone or with fentanyl has provided effective surgical anesthesia for transurethral resection of prostrate and hemodynamic stability in elderly patients.

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“…In contrast to our study, other studies comparing Ropivacaine versus Ropivacaine plus Fentanyl, there was no significant difference in sensory onset in two groups. 9,10,16,17 It could be attributed to two factors, firstly, in study by Gupta et al 16 and Seetharam et al 17 normal saline was added in 'Ropivacaine only' Group to make equal volume as in 'Ropivacaine + Fentanyl' Group. Intrathecal solution in both Groups thus became hypobaric and similar sensory onset was observed.…”

“…Ropivacaine has been successfully used in spinal anaesthesia for caesarean section, nephrotic surgery and orthopaedic surgery of lower extremity. [8][9][10][11][12] However there is scarcity of data in which ropivacaine has been used in SAB for vaginal hysterectomy in which there is more extensive surgery, needing more relaxation than above mentioned surgeries. 13 This prompted us to plan present study.…”

“…When fentanyl or dexmedetomedine were added to intrathecal ropivacaine better clinical profile was noted as compared to ropivacaine alone. [9][10][11][12][13][14] However, limited study material available comparing efficacy of fentanyl versus dexmedetomidine as an adjuvant to ropivacaine in spinal anesthesia has been conducted to date. Therefore, we have planned present study using ropivacaine alone and with dexmedetomidine or fentanyl in spinal anesthesia for vaginal hysterectomy.…”

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

“…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 adjuncts to local anaesthetics in regional block.…”

“…2 Ropivacaine could provide adequate surgical anaesthesia without compromising early ambulation and discharge. 2 Corticosteroids have been studied recently as adjuncts to local anaesthetics in regional block. 3 Ropivacaine is less lipophilic than bupivacaine and is associated with decreased potential for central nervous system toxicity and cardiotoxicity.…”