Abstract

Background: For the majority of endoscopic urological operations, spinal anesthesia is the recommended anesthetic approach because it offers enough muscle relaxation and efficient intraoperative analgesia. Hyperbaric 0.5% bupivacaine is widely used for subarachnoid block; however, higher doses may produce hypotension, prolonged motor blockade, and delayed recovery, particularly in elderly patients. It has been demonstrated that intrathecal fentanyl improves block quality, permits dose reduction, and increases the analgesic effectiveness of local anesthetics. Objective of the study: To assess the sensory block properties of intrathecal 0.5% hyperbaric bupivacaine (10 mg) and 0.5% hyperbaric bupivacaine (7.5 mg) in combination with 25 mcg of fentanyl in patients having endoscopic urological procedures. Methods: Forty ASA physical status I and II participants who were scheduled for elective endoscopic urological surgery under spinal anesthesia were included in this prospective observational study. Two groups of twenty participants each were formed. Group BF received 7.5 mg of 0.5% hyperbaric bupivacaine with 25 mcg of fentanyl intrathecally, while Group B received 10 mg of 0.5% hyperbaric bupivacaine. Time to commencement of sensory block, time to peak sensory block, and duration of sensory blockade were the main outcome measures. With statistical significance set at p < 0.05, the independent Student’s t-test was used for intergroup comparisons after data analysis using SPSS. Results: Participants in Group BF demonstrated a significantly faster onset of sensory blockade than those in Group B (3.40 ± 0.60 vs. 5.30 ± 0.57 minutes; p <0.001). Peak sensory block was also achieved earlier in Group BF (6.95 ± 0.89 vs. 7.85 ± 0.59 minutes; p < 0.001). In addition, the duration of sensory blockade was significantly longer in Group BF (214.50 ± 8.87 vs. 140.75 ± 4.94 minutes; p < 0.001). Conclusion: In comparison to conventional-dose hyperbaric bupivacaine alone, the addition of 25 mcg intrathecal fentanyl to low-dose hyperbaric bupivacaine produced a faster onset, earlier peak, and noticeably longer duration of sensory blockade. This combination may represent an effective spinal anesthetic technique for endoscopic urological procedures, particularly in elderly patients.

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