Dural Puncture Epidural Anesthesia, Rigid Cystoscopy, Spinal Anesthesia
Conditions
Brief summary
The main objective of this study was to determine if the dural puncture epidural (DPE) anesthesia provides superior analgesia and better patient satisfaction when compared to traditional spinal anesthesia for rigid cystoscopy.
Detailed description
Most urologic surgeries are performed in a narrow and limited space with the minimally invasive technique or cystoscope, and most patients undergoing urologic surgeries are elderly individuals with other diseases. Cystoscopic evaluation of the lower urinary tract is a vital part of an office-based urologic practice. However, regular surveillance cystoscopy is a significant source of morbidity for patients, and therefore attempts have been made to minimize discomfort secondary to this procedure. Spinal anesthesia is popular for endoscopic urological surgery because of early recognition of symptoms caused by overhydration, transurethral resection of prostate (TURP) syndrome and bladder perforation. The dural puncture epidural (DPE) technique is a modification of the combined spinal epidural (CSE) technique, where a dural perforation is created from a spinal needle but intrathecal medication administration is withheld. The DPE technique has been shown to improve caudal spread of analgesia compared with epidural (EPL) technique without the side effects observed with the CSE technique.
Interventions
DRUGhyperbaric bupivacaine and fentanyl
Patients received 3ml hyperbaric bupivacaine 0.5% combined with 25 microg of fentanyl.
DRUGplain bupivacaine and fentanyl
Patients received 15 mL mixture of (0.25% plain bupivacaine and 50 µg fentanyl) over 5 minutes, injected in the epidural space by epidural catheter at L3-L4 interspace, a dural puncture was created by the spinal needle. Braun's Espocan® combined spinal epidural kit before insertion of epidural catheter (needle-through-needle technique) but intrathecal medication administration was withheld.
Sponsors
Tanta University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Subject, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age ≥18 years. * Both sex. * American Society of Anesthesiology (ASA) physical status I, II, III. * Admitted for elective rigid cystoscopy.
Exclusion criteria
* Refusal of patients. * Body Mass Index (BMI) \> 35. * Patients who have history of substance abuse. * Patients with difficult communication. * Contraindication to neuraxial anesthesia (e.g.; infection near the site of injection, coagulopathy or bleeding disorder). * Patients with history of allergy to local anesthetics.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Assessment of the onset of anesthesia | Every 15 minutes till end of the surgery | Assessment of the onset by test sensory loss at T10 by pin prick using sterile needle with blunt edge (defined as time from end of injection of bolus dose to 1st sign of sensory block at T10). Sensory level of the techniques which was assessed at 2 min after end of injection of the drug then every 5 min till the 30 min then every 15 min till end of the surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Time of onset of motor block | Till the end of the surgery | Time of onset of motor block was assessed from end of drug injection to time of achieving Breen Modified Bromage scale (BMBS) grade 1) in the lower extremities was assessed by using a BMBS: Grade 1 as complete motor block to Grade 6 as no motor block) and it was assessed at 2 min then every 3 min after injection of the drug till 30 min then every 15 min till the end of the surgery. |
| Incidence of side effects | 24 hours postoperatively | Incidence of side effects such as (hypotension and bradycardia) were recorded. |
| Number of patients required rescue analgesia | 24 hours postoperatively | Number of patients required rescue analgesia was measured. |
Countries
Egypt
Outcome results
None listed