Selective spinal anesthesia versus intravenous propofol in transrectal ultrasound-guided prostate biopsy

Abstract

Background: Selective spinal anesthesia (SSA) focuses on the use of minimal doses of intrathecal agents with greater precision and selectivity so that return of function occurs rapidly. Objective: The authors compared the efficacy of 1.25 mg of hyperbaric bupivacaine intrathecally with propofol anesthesia in terms of hemodynamic stability, surgical conditions and ability to bypass the post anesthetic care unit (PACU). Material and Method: Seventy male patients, 45-85 years old, ASA physical status I-III, were randomly allocated into two groups. Group 1 (n = 35) received intrathecal 1.25 mg hyperbaric bupivacaine plus patient's cerebrospinal fluid 0.75 ml. Group 2 (n = 35) received propofol 1-1.5 mg/kg IV bolus dose and 6-10 mg/kg/hr infusion to maintain surgical anesthesia. Results: The patients in group 1 had adequate anesthesia and were able to walk and bypass the PACU (100%). The need of supplemental oxygen and airway maneuver, the incidence of hypotension and bradycardia were found only in group 2. The surgical conditions were rated as excellent 100% in group 1 and 57.1% in group 2. Conclusion: SSA is superior to propofol anesthesia in terms of hemodynamic stability, surgical conditions and recovery profiles. Even elderly patients were able to walk out from the operating theatre immediately after the procedure.