Analysis of the effectiveness of the use of spinal anesthesia in urological practice


To evaluate the effectiveness of the use of spinal anesthesia (SA) in elderly patients of urological profile.

Materials and methods:

The studies were carried out on the basis of City Clinical Hospital №1 in Shymkent in 52 patients aged 65 to 84 years during operations: elimination of urethral stricture, transurethral resection of diffusely hyperplastic prostate gland. Concomitant pathology: hypertension (37%); Ischemic heart disease, angina pectoris (24.5%); COPD (14.0%). All patients underwent a standard preoperative examination, including general blood and urine analysis, biochemical blood test, coagulogram, electrocardiogram, chest X-ray, consultations of related specialists. The risk of anesthesia was assessed by stages 1-3 by ASA. Intraoperative monitoring included measuring blood pressure, heart rate, SpO2.

Within 50-80 minutes before the operation, up to 800.0 ml of crystalloid solutions were pre-infused. No premedication was performed.

In the sitting position of the patient, at the L3-L4 level, the spinal space was punctured with a Quincke needle (26g). After identification of the spinal canal, bupivacaine (0.5%) was administered at a dose of 10-15 mg.

The criteria for the effectiveness of anesthesia were determined by the visual analogue pain scale (VAS) intraoperatively and in the early postoperative period, motor block according to Bromage [1].

Observation results:

It was found that 27% of patients had hypotension with a decrease in SBP from the initial level to 30 mm Hg. For correction, the introduction of up to 1200 ml of crystalloids and 500 ml of gelofusin was used, 4% additionally required the use of dopamine[2] at a dose of 8-10 mcg / kg / min. In 12% of patients, for the purpose of sedation, diazepam[3] at a dose of 0.1-0.2 mg / kg / hour.

All patients had complete absence of pain during the operation. The sensory block remained up to the T12 level, the motor block: 3-4 st. In the postoperative period, the analgesic effect lasted up to 3-4 hours, which reduced the need for the use of analgesics by 2 times.


The use of bupivacaine at a dose of 10-15 mg for SA in elderly patients showed an adequate level of anesthesia without significant hemodynamic disturbances.

Used literature: 1. M. Malroy, Local anesthesia, BINOM, 2007

2.Ronald Millers Anesthesia 2016.

3.Barash, Paul G.; Cullen, Bruce F.; Stoelting, Robert K. Clinical Anesthesia, 5th Edition Copyright ©2014

Lippincott Williams & Wilkins.

Year: 2020
City: Shymkent
Category: Medicine