Combined Spinal-Epidural Anesthesia for Transurethral Resection of the Prostate

Lee, Kyu Tak; Chung, Choon Kun

Abstract

BACKGROUND: The technique of combined spinal-epidural anesthesia (CSE) may offer theoretic advantages for the various surgeries, because it produces the rapid onset of spinal anesthesia, with the option to extend the blockade and postoperative pain control with an epidural catheter. In this study, we attempt to evaluate both advantages and disadvantages of the CSE for transurethral resection of the prostate (TURP).
METHODS
Fifteen patients scheduled to undergo TURP were involved in our study. In all patients, a 17 G Tuohy needle was introduced into the epidural space at L3-4 or L4-5 interspace. Using the needle-through-needle technique, each patients received a subarachnoid injection of 8 mg hyperbaric bupivacaine through a 25 G Whitacre needle. After withdrawal of the Whitacre needle, an epidural catheter was inserted into the epidural space. The level of sensory blockade was checked by pinprick test every 1~2 minute for 30 minutes. Epidural postoperative pain control was done after operation. Postoperatively, we evaluated the adverse effects and the quality of postoperative pain control.
RESULTS
The time from start of anesthesia to the time for a T10 sensory block and the time to start of surgery were 6+/-2 min and 21+/-3 min, respectively. At 5, 10, 15 and 20 minutes after spinal anesthesia, sensory blockade level was T10+/-1, T7+/-2, T6+/-2, and T5+/-1, respectively. In general, the quality of anesthesia was good, and most of the patients were satisfied with postoperative pain control.
CONCLUSIONS
CSE provided reliable anesthesia and excellent postoperative analgesia for TURP.