EFFECTIVENESS OF SADDLE BLOCK VS SPINAL ANAESTHESIA IN TURP: AN OPEN LABEL RANDOMIZED CONTROL TRIAL
DOI:
https://doi.org/10.55519/JAMC-01-11451Keywords:
Haemodynamic Stability, Spinal Anaesthesia, Saddle Block Anaesthesia, TURP, VasopressorAbstract
Background: One of the most frequent diseases among male gender is benign prostatic hyperplasia. Transurethral resection of the prostate (TURP) is a minimally invasive procedure for resection of prostate through endoscopic technique. Recently there was a debate on role of saddle block in TURP. There we aimed to determine the effectiveness of spinal anaesthesia versus saddle block in terms of hemodynamic stability and vasoprbessor requirement in TURP. Methods: This open label randomized control trial was performed at Hamdard University Hospital, Karachi, Pakistan, during 1st October, 2021 to 31st March, 2022. Male patients of age 45–65 years requiring TURP, with well controlled diabetes and hypertension of ASA grade I-II were included into the study and randomly assigned into two study groups. Patients’ parameters including blood pressure, heart rate, mean arterial pressure and oxygen saturation (SPO2) were measured at baseline and intraoperative at every fifth minute interval till surgery completion. Patients’ other parameters including age, surgery duration and comorbidity were also recorded. Results: Total 60 patients with 30 patients in each group were enrolled into the study. Maximum fall in systolic blood pressure, diastolic blood pressure, pulse rate and mean arterial pressure from baseline was significantly lower in patients receiving saddle block anaesthesia than spinal anaesthesia. Maximum fall in SPO2 was not significantly different among two study groups. Maximum fall in all parameters excluding SPO2 was significant between two groups for initial 20 minutes of the procedure. No statistically significant maximum fall was seen for all of the parameters beyond 20 minutes of the procedure. Vasopressor consumption was significantly lower in saddle block group than spinal anaesthesia. Conclusion: Application of saddle block anaesthesia is effective for TURP procedure with controlled hemodynamic status than spinal anaesthesia. Moreover, saddle block requires less vasopressor consumption than spinal anaesthesia technique.References
Abt D, Hechelhammer L, Müllhaupt G, Markart S, Güsewell S, Kessler TM, et al. Comparison of prostatic artery embolisation (PAE) versus transurethral resection of the prostate (TURP) for benign prostatic hyperplasia: randomised, open label, non-inferiority trial. BMJ 2018;361:k2338.
Leslie SW, Chargui S, Stormont G. Transurethral Resection Of The Prostate. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Sep 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK560884/
Kiasari AZ, Babaei A, Alipour A, Motevalli S, Baradari AG. Comparison of Hemodynamic Changes in Unilateral Spinal Anaesthesia Versus Epidural Anaesthesia Below the T10 Sensory Level in Unilateral Surgeries: a Double-Blind Randomized Clinical Trial. Med Arch 2017;71(4):274–9.
O'Donnell AM, Foo IT. Anaesthesia for transurethral resection of the prostate. Contin Educ Anesth Crit Care Pain 2009;9(3):92–6.
Olawin AM, M Das J. Spinal Anaesthesia. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 [cited 2022 Sep 22]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537299/
Kshetrapal K, Mishra P, Kamal H, Bansal P. Is Saddle block superior to spinal anaesthesia for patients undergoing transurethral resection of prostate-a comparative evaluation. Asian J Med Sci 2021;12(10):105–10.
Cantürk M, Kılcı O, Ornek D, Ozdogan L, Pala Y, Sen O, et al. Ropivacaine for unilateral spinal anaesthesia; hyperbaric or hypobaric? Rev Bras Anestesiol 2012;62(3):298–311.
Bhattacharyya S, Bisai S, Biswas H, Tiwary MK, Mallik S, Saha SM. Regional anaesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block. Saudi J Anaesth 2015;9(3):268–71.
Abdulqader FT, Mohammed AA. Comparison of hemodynamic effect between the spinal anaesthesia and saddle block during transurethral resection of the prostate. J Univ Shanghai Sci Technol. 2021;23(9):817–28.
Stefani LC, Gamermann PW, Backof A, Guollo F, Borges RMJ, Martin A, et al. Perioperative mortality related to anaesthesia within 48 h and up to 30 days following surgery: A retrospective cohort study of 11,562 anesthetic procedures. J Clin Anesth 2018;49:79–86.
Cooper JB. Critical Role of the Surgeon-Anesthesiologist Relationship for Patient Safety. Anesthesiology 2018;129(3):402–5.
Santoro E, Colace L, Pedullà G, Pullano C. Spinal and Epidural Anaesthesia for Laparoscopic Abdominal Surgery: 84 Procedures. World J Surg Surg Res 2021;4:1334.
Tyritzis SI, Stravodimos KG, Vasileiou I, Fotopoulou G, Koritsiadis G, Migdalis V, et al. Spinal versus General Anaesthesia in Postoperative Pain Management during Transurethral Procedures. ISRN Urol 2011;2011:895874.
Dohlman LE, Kwikiriza A, Ehie O. Benefits and Barriers to Increasing Regional Anaesthesia in Resource-Limited Settings. Local Reg Anesth 2020;13:147–58.
Elkady OMF MN, Salim AEE, Eldaba AA. Hemodynamic changes during spinal anaesthesia with different bupivacaine concentrations in elderly cardiac patients undergoing transurethral resection of prostate. J Adv Med Med Res 2021;33(7):99–108.
Carpenter RL, Caplan RA, Brown DL, Stephenson C, Wu R. Incidence and risk factors for side effects of spinal anaesthesia. Anesthesiology 1992;76(6):906–16.
Yung EM, Abdallah FW, Todaro C, Spence E, Grant A, Brull R. Optimal local anesthetic regimen for saddle block in ambulatory anorectal surgery: an evidence-based systematic review. Reg Anesth Pain Med 2020;45(9):733–9.
Shon YJ, Huh J, Kang SS, Bae SK, Kang RA, Kim DK. Comparison of saddle, lumbar epidural and caudal blocks on anal sphincter tone: A prospective, randomized study. J Int Med Res 2016;44(5):1061–71.
Bejoy R, Thomas D, Beevi S. Saddle block versus subarachnoid block for transurethral resection of prostate surgery: A randomized comparative study. Bali J Anesthesiol 2020;4(4):178.
Steel WA. Blood pressure maintenance in spinal anaesthesia. J Am Med Assoc 1925;84(2):79.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
