Open Access

ARTICLE

Transurethral resection of the prostate (TURP) with low dose spinal anesthesia in outpatients: a 5 year review

Busara Sirivanasandha, Pamela H. Lennox, Himat Vaghadia

Department of Anesthesia, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
Address correspondence to Dr. Pamela H. Lennox, Department of Anesthesia (JPP 2449), Vancouver General Hospital, 855 West 12^th Avenue, Vancouver, BC V5Z 1M9 Canada

Canadian Journal of Urology 2011, 18(3), 5705-5709.

Abstract

Introduction: Spinal anesthesia for ambulatory transurethral resection of the prostate (TURP) is a well-established technique. This study reviews data collected over a 5-year period at a major Canadian tertiary academic center. The purpose of the study was to evaluate our experience and complications associated with spinal anesthesia using a combination of low-dose local anesthetic and narcotic in ambulatory TURP procedures.
Methods: Medical records were retrospectively reviewed for all ambulatory TURP patients treated between January 2000 and September 2005 at our Surgical Day Care Center. All spinal anesthetics were reviewed and classified based on dosage into: low-dose bupivacaine (< 10 mg; Group LD-B), conventional-dose lidocaine (> 35 mg; Group CD-L), or low-dose lidocaine (≤ 35 mg; Group LD-L). Primary endpoints included duration of spinal block and length of postanesthesia care unit (PACU) stay.
Results: A total of 1064 TURPs were performed during the study period. Among the 334 spinal anesthetics administered, 27 cases were excluded due to incomplete data, leaving 307 cases for analysis. Patient demographics were normally distributed. Mean doses of spinal local anesthetics administered were: Group LD-B 7.3 ± 2 mg, Group CD-L 52.2 ± 13 mg, and Group LD-L 29 ± 5.2 mg. Intrathecal fentanyl was frequently added as an adjunct. Block regression times were significantly shorter in both lidocaine groups compared to Group LD-B (Group LD-B 273 ± 98 min, Group CD-L 174 ± 47 min, Group LD-L 159 ± 45 min). Similarly, discharge times were shorter (Group LD-B 309 ± 94 min, Group CD-L 230 ± 71 min, Group LD-L 227 ± 75 min; p < 0.05). The frequency of prolonged spinal blocks (> 3 hours) was 23% in Group LD-L, 43% in Group CD-L, and 83% in Group LD-B (p < 0.05).
Conclusion: Low-dose spinal anesthesia with bupivacaine and lidocaine was well tolerated for short-duration TURP procedures. However, low-dose bupivacaine and conventional-dose lidocaine were associated with significantly longer block duration, longer PACU stays, and higher rates of prolonged blocks compared to low-dose lidocaine. These findings suggest that low-dose lidocaine may be preferable for ambulatory spinal anesthesia in TURP.

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