Dural Puncture Epidural Anesthesia Versus Traditional Spinal Anesthesia for Rigid Cystoscopy

Tanta University

Status: Completed

Conditions: Spinal Anesthesia; Rigid Cystoscopy; Dural Puncture Epidural Anesthesia

Treatments: Drug: plain bupivacaine and fentanyl; Drug: hyperbaric bupivacaine and fentanyl

Study type: Interventional

Funder types: Other

Identifiers

NCT06507397

35621/8/22

Details and patient eligibility

About

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.

Full 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.

Enrollment: 76 patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

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.

Trial design

Primary purpose: Prevention

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Double Blind

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76 participants in 2 patient groups

Spinal Anesthesia

Active Comparator group

Description:

Patients received 3-ml hyperbaric bupivacaine 0.5% and 25 mcg fentanyl (0.5-ml).

Treatment:

Drug: hyperbaric bupivacaine and fentanyl

Dural Puncture Epidural Anesthesia

Experimental group

Description:

Patients received 15-ml mixture of bupivacaine 0.25% and 50 mcg 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.

Treatment:

Drug: plain bupivacaine and fentanyl