COMPARATIVE EVALUATION OF INTRATHECAL ISOBARIC LEVOBUPIVACAINE 0.5% AND ISOBARIC ROPIVACAINE 0.5% IN TRANSURETHRAL RESECTION OF PROSTATE SURGERIES- AN OBSERVATIONAL STUDY

Abstract

Background- Levobupivacaine and ropivacaine are the two recently introduced alternatives to bupivacaine in clinical practice. We compared the efficacy of intrathecally administered isobaric 0.5% levobupivacaine and isobaric 0.5% ropivacaine in transurethral resection of prostate (TURP) surgeries in terms of characteristics of sensory and motor blockade and intra-operative hemodynamic stability.
Objectives- To compare onset and duration of motor block, characteristics of sensory blockade, hemodynamic stability and side effect profile between the isobaric ropivacaine and isobaric levobupivacaine after spinal anaesthesia in TURP patients.
Study Design- An observational study
Participants- Male patients >60 years of age undergoing TURP.
Methods- 100 patients of BPH of ASA class I & II with age > 60 years, submitted for TURP were divided into two groups of 50 each. Group I received 2.5 ml [12.5 mg] of intrathecal isobaric ropivacaine [0.5%] with 0.5 ml of fentanyl [25 ug] a total of 3 ml. Group II received 2.5 ml [12.5 mg] of isobaric levobupivacaine 0.5% with 0.5 ml of fentanyl [25 ug] a total of 3 ml.
Results- Patients in levobupivacaine group showed statistically significant (p<0.05) faster onset and longer duration of sensory and motor blocks. Results were statistically significant (p<0.05) with respect to median level of sensory block attained with T6 in levobupivacaine group and T8 in ropivacaine group. Levobupivacaine group showed statistically significant (p<0.05) longer duration of postoperative analgesia as compared to ropivacaine group. Ropivacaine group showed statistically significant (p<0.05) higher incidence of bradycardia as compared to levobupivacaine group.
Conclusion- 0.5% isobaric ropivacaine with fentanyl and 0.5% isobaric levobupivacaine with fentanyl provide adequate spinal block for TURP. Ropivacaine can be used for day care surgeries with early ambulation and faster home discharges, levobupivacaine is better for surgeries who need prolonged duration of spinal anaesthesia.
Implications- It is better to give levobupivacaine for spinal anaesthesia for surgeries having prolonged duration.