@2024 Afarand., IRAN

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ISSN: 2252-0805    The Horizon of Medical Sciences 2016;22(4):261-266

Background
Spinal anesthesia is an optional technique for transurethral incision of the prostate (TURP) [1].
Previous Studies
... [2-4]. Adding a narcotic drug with a reduced dose of local anesthetic in spinal anesthesia can decrease the side effects of local anesthetic and improve the recovery from spinal blocks, without endangering the intraoperative anesthesia or analgesia period after the surgery [5, 9]. ... [6-8].
Aim(s)
The aim of this study was to compare hemodynamic changes in spinal anesthesia with 5% lidocaine (conventional method) and with lower dose of 5% lidocaine plus 50 micrograms of fentanyl in older patients with a history of systemic high blood pressure in the TURP surgery.
Research type
This study is a double blind clinical trial.
Research society, place and time
The samples were selected from among the patients who had referred to the operating room of 15 Khordad Hospital, Gonabad during 2001 – 2002 for TURP surgery.
Sampling method and number
The sample size was considered 74 patients for each group and 148 people totally according to the results of a similar study [5]. Simple random sampling was utilized. Subjects of the study were non-addicted men over 50 years old with ASA (American Society of Anesthesiologists Association) Class II, with a history of systemic controlled high blood pressure and lack of coagulation disorders. Exclusion criteria were unwillingness to continue the research and spinal, inability to maintain immobility during the sticking of spinal needle, the possibility of increased intracranial pressure, the infection of skin or soft tissue of spinal area, severe hypovolemia, lumbar disc herniation or a history of lumbar spine surgery, and the need for transfusion during surgery. Patients were divided randomly into two groups of 74 people.
Used devices&materials
First, all patients entered the study received 5 ml per kg of saline after recording their demographic characteristics. Patients were full monitored (blood pressure, heart beat, ECG and pulse oximetry) and then while being sterilized, the first group was under spinal anesthesia with 2 cc of 5% lidocaine (100 mg) as was the second group with 1 cc of 5% lidocaine (50 mg) plus 1 cc of fentanyl (50 micrograms) of L4-L5 or L5-S1 intervertebral space. Heart beat and blood pressure monitoring was measured and recorded every 5 minutes with LX 110 automatic monitoring device (portable cardio set monitor; Iran) immediately after spinal anesthesia. In case of hemodynamic instability, it came down to one minute. If the decrease of blood pressure was more than 20% of the baseline, it would be treated and recorded with ephedrine. Moreover, if the patient's heart beat decreased to less than 45 pulses in a minute, it would be treated with atropine. Intraoperative fluid therapy was done according to the related laws and in case of excessive bleeding, PRBC transfusion (Packed Red Blood Cells) was done and patients were excluded from the study. The patients and assessors were not aware of the kind of prescribed drugs of lidocaine or lidocaine + fentanyl and the study was double-blind.Collected data was statistically analyzed using SPSS 21 software. First, the distribution of data in both groups was evaluated through Kolmogorov-Smirnov normality test. Then, according to the normal distribution of data, independent T-test was used to compare the mean of quantitative variables between two groups. Besides, to examine the relationship between qualitative variables and the studied groups, Fisher's exact test was deployed.
Findings by Text
... [10-13]. 148 patients were studied and no patients were excluded from the research. In the Lidocaine group, 12, 25, 34 and 3 patients were in the age range of 51-60, 61-70, 71-80 and 81-90, respectively. In Lidocaine + Fentanyl group, 5, 11, 35, 19 and 4 patients were in the age range of 51-60, 61-70, 71-80, 81-90 and 91-100, respectively. The mean reduction of systolic and diastolic blood pressure was less than Lidocaine group in Lidocaine + Fentanyl group, and there was a significant statistical difference between the two groups (p <0.001). The mean reduction of heart beats in Lidocaine + Fentanyl group was significantly lower than in lidocaine group (p=0.009). In the Lidocaine group, 26 patients needed to use intravenous ephedrine to modify the lower blood pressure and 19 patients required intravenous atropine to adjust bradycardia, while in Lidocaine + Fentanyl group, none of the patients came to use ephedrine or atropine which this brought significant statistical difference between the two groups (p <0.001 ; Table 1).In both groups, patients were pleased with the quality of analgesia and did not require intravenous fentanyl or general anesthesia.
Main comparison to the similar studies
The addition of fentanyl to lidocaine in spinal anesthesia makes the patient`s anesthesia and analgesia much stronger and longer, without prolonging the recovery [2, 4, 14]. ... [15-18].
Suggestions
Low dose of lidocaine (50 mg) with fentanyl (50 micrograms) can be used for anesthesia and analgesia in surgeries of older patients with a history of controlled hypertension.
Limitations
Lack of blood pressure control in patients is one of the limitations of this study.
Conclusions
Low dose of lidocaine (50 mg) with fentanyl (50 micrograms) can provide sufficient anesthesia and analgesia for TURP surgery, without causing hemodynamic instability in elderly patients with a history of controlled hypertension.
Acknowledgments
Regards are addressed to the authorities, doctors and the operation room staff of 15 Khordad Hospital and Research Department of Gonabad University of Medical Sciences for cooperating in this research project as well as all the patients participating in this study.
Conflict of interest
Non-declared
Ethical Permissions
Under the code of IRCT: 201107207064N1, this study has the ethics license of the Ethics Regional Council in Research Department of Gonabad University.
Funding Sources
This article has been approved and funded by the Research Council of Gonabad University of Medical Sciences.

TABLES and CHARTS

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