Comparison of Spinal and Epidural Anesthesia for Transurethral Resection of Prostate (TURP)

Shin, Hye Weon; Joo, Koung Hwa; Suh, Kuy Suk; Yoo, Tag Keun

Abstract

BACKGROUND: The purpose of this study was to determine whether spinal or epidural anesthesia is more suitable in terms of sensory and motor blockade, cardiovascular stability, intraoperative blood loss, postoperative recovery and patient satisfaction in elderly patients undergoing TURP.
METHODS
Fourty patients undergoing TURP were randomly allocated to either a spinal or an epidural anesthesia group. The spinal group (n = 20) received 10 12 mg of 0.5% tetracaine in 10% dextrose, while the epidural group (n = 20) received 20 25 ml of 2% lidocaine at L4-5 intervertebral space. After injection of the agent, changes in sensory and motor blockade, blood pressure and heart rate were measured in the two groups. We compared serum Hb, serum Na, foley removal, hospital stay, side effects, analgesic use, and patient satisfaction between the two groups.
RESULTS
The two techniques were similar with regard to the level of blood pressure, heart rate, Hb and Na changes, foley removal and hospital stay. At 15 and 30 minutes after spinal and epidural anesthesia, the results for sensory blockade were T8 +/- 2.2 S5, T9 +/- 1.2 S5 (spinal) and T10 +/- 1.5 S3, T8 +/- 2.1 - S4 +/- 1.0 (epidural), and motor blockade was complete in the spinal group but incomplete in the epidural group. Patient satisfaction was better in the epidural group than in the spinal group, but analgesic use was more frequent in the spinal group than in the epidural group.
CONCLUSIONS
Both spinal and epidural anesthesia are suitable for TURP. Spinal anesthesia was technically easier and produces a complete and more reliable block of the sacral segment, but was also an unnecessarily profound motor block of the lower extremity. Epidural anesthesia is less pronounced and gives a shorter duration of motor blockade with good patient satisfaction.