Abstract
In this prospective, randomized study, 23 patients having spinal anaesthesia for transurethral prostatectomy (TURP) were evaluated for the adequacy of their block using a visual analog pain score (V4 PS). Each patient with a “standard”(≥T10) block level (n = 5) or “intermediate” (L1 or T12) block level (n = 5) found the block adequate. Sixty-two percent (8/13) of patients with a “low”-L3) block level found their block adequate. The VAPS was assessed every five minutes or whenever pain abruptly increased during TURP; an “inadequate block” was defined as a V4 PS ≥ 5 /10 during prostatic resection. Intravesical pressure was monitored and kept <15 mmHg to distinguish between pain from bladder distension and from prostatic resection. “Low” block patients (LBP) who found their block inadequate (n = 5) received supplemental intrathecal local anaesthetic given through a spinal catheter. The subsequent L1 block level was adequate for TURP. In LBP, who found their block adequate (n = 8), a higher (P < 0.01) VAPS was observed than in patients with a “standard” block level. However, a smaller (P < 0.05) maximum percent decrease in diastolic blood pressure was found in LBPs, than in “intermediate” or “standard” block patients. It is concluded that a spinal block ≥L1) is adequate during TURP when bladder pressure is monitored and kept low. Mid-lumbar block levels should be reserved for patients in whom the benefit of minimizing haemodynamic changes outweighs the risk of a “less complete” anaesthetic.
Résumé
Au cours de cette étude prospective randomisée, l’efficacité de la rachianesthésie est évaluée sur une échelle visuelle analogique (EVA) chez 23 patients soumis à une résection transuréthrale de la prostate (RTUP). Chaque patient (n = 5) bloqué au niveau « standard » (≥T10) ou « intermédiaire » (L1ou T12) a trouvé le bloc suffisant. Soixante-deux pourcent (8/13) des patients avec un niveau « bas » (≤L3 ont trouvé le niveau suffisant. Le score d’EVA a été évalué aux cinq minutes à chacun des moments où la douleur a augmenté subitement pendant la RTUP; le bloc a été considéré comme insuffisant lorsque l’EVA ≥ 5/10 pendant la résection. La pression intravésicale a été monitorée et maintenue < 15 mmHg pour distinguer la douleur de la distension vésicale de celle de la résection prostatique. Les patients à niveau « bas » (PNB) qui ont trouvé le bloc insuffisant (n = 15) ont reçu un supplément d’anesthésique local par un cathéter intrarachidien. Le niveau à L1,a été par la suite considéré comme suffisant pour la RTUP. Chez les PNB qui ont trouvé le bloc suffisant (n = 8), un EVA plus élevé (P < 0,01) a été rapporté que chez les patients avec un niveau « standard ». Cependant, une plus petite baisse maximale (P < 0,05) de la pression artérielle diastolique a été constatée chez les PNB que chez les patients à bloc « standard » ou « intermédiaire ». En conclusion, un bloc rachidien ≥L1 est adéquat pendant la RTUP en autant que la pression vésicale est gardée basse. Les niveaux mid-lombaires devraient être réservés aux patients chez qui le bénéfice d’atténuer les modifications hémodynamiques est supérieur au risque d’une anesthésie moins complète.
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Beers, R.A., Kane, P.B., Nsouli, I. et al. Does a mid-lumbar block level provide adequate anaesthesia for transurethral prostatectomy?. Can J Anaesth 41, 807–812 (1994). https://doi.org/10.1007/BF03011588
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DOI: https://doi.org/10.1007/BF03011588