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

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.