Better Outcomes with Saddle Block in HoLEP in the Treatment of BPH

2 Dec, 21

Introduction

Although transurethral resection of the prostate (TURP) has been widely used in the treatment of benign prostatic hyperplasia (BPH), Holmium laser enucleation of the prostate (HoLEP) has better long-term outcomes and is associated with better safety and efficacy. Different types of regional anesthesia for TURP surgery have been compared, there is lack of data on the anesthetic aspects of HoLEP, since the scientific literature has focused on the urological aspects of HoLEP.

Aim

Different regional anesthesia methods for HoLEP operation were compared the optimal technique was determined in this study.

Method

Study Design

Prospective, randomized comparative study.

Treatment Strategy

Sixty patients with American Society of Anesthesiologists Physical status scores of I-III were recruited.
The cohort underwent the cardiopulmonary monitoring and then were randomized into 3 groups of 20 patients each.
Group E received an epidural block with 75?mg of bupivacaine plus 50??g of fentanyl
Spinal anesthesia with 15?mg of bupivacaine and 50??g fentanyl was performed in Group S.
Group SA received saddle block with 15?mg of bupivacaine and 50??g of fentanyl.

Endpoints

Time to block of thoracic 10 (T-10) dermatome
Time to maximum sensory block
Maximum sensory block level
Time to 2-segment regression

Results

All the groups had comparable demographics, duration of surgery, pre- and postoperative sodium levels at baseline.
Group E required longest time to attain T10 dermatome block and maximal sensory level block (P?<?.05).
Group E had higher maximal sensorial block level as compared to group SA (P?<?.05).
There was a significant difference in postoperative motor block, however, the difference in systolic blood pressure and heart rate was insignificant.

Conclusion

Saddle block induced by the combination of 15?mg 0.5% bupivacaine and 50??g fentanyl seems to be a preferrable option in HoLEP due to rapid sensory regression time and weaker postoperative motor blockade with stable hemodynamic changes.
Saddle block was associated with more rapid onset and effective sensory block.

Medicine (Baltimore). 2021 Oct 22; 100(42): e27534.