Use of a local anesthetic and opioid combination in spinal anesthesia in short urologic surgeries


  • Abdullah özdemir Department of Anesthesiology And Reanimation, Recep Tayyip Erdogan University Medical School, Rize, Turkey
  • Mehmet Salih Çolak Department of Anesthesiology And Reanimation, Karadeniz Technical University Medical Faculty, Trabzon, Turkey



Local anesthetics, Short urologic surgerie, Spinal anesthesia


Background: To investigate how low-dose levobupivacaine affects both surgical comfort and hemodynamics in patients undergoing short urologic procedures using spinal anesthesia.

Methods: Our study was conducted prospectively and double-blind. The study group comprised 40 patients aged 18-65 years from the ASA I-III risk group who had undergone short urological interventions, randomly split into two groups. Informed consent and ethics committee approval were received. Using a media approach and placed in the lateral decubitus position, the patients were given spinal anesthesia using 22 G catheter. Group L was given 1.5ml of levobupivacaine (7.5mg) at 0.5% concentration +0.5ml of saline. Group LF was given 1.2ml levobupivacaine (6mg) at 0.5% concentration +25μg fentanyl (0.5ml) +0.3ml saline. Patient data including peripheral oxygen saturation; systolic, diastolic, mean arterial pressure; time to first postoperative need for analgesics, and spinal block characteristics were recorded at 3, 5, 10, 15, 30, 60, 120 and 360minutes after spinal anesthesia.

Results: No significant differences were observed in the demographic and hemodynamic data between groups. Motor blocks were seen to wear off more in Group LF than in Group L at 120minutes. Group LF required first postoperative analgesics later than Group L; this difference was not significant.

Conclusions: Sufficient anesthesia was achieved in both groups via spinal block using local anesthetic or local anesthetic plus opioid for relatively short urological procedures. The latter group recovered faster.


Dobson PM, Caldicott LD, Gerrish SP, Cole JR, Channer KS. Changes in haemodynamic variables during transurethral resection of the prostate: comparison of general and spinal anaesthesia. BJA: Brit J Anaesth. 1994 Mar 1;72(3):267-71.

Malhotra V. Anesthesia for Renal and Genito-Urologic Surgery. 1th ed. New York, NY: McGraw-Hill; 1996:240-98.

Luck JF, Fettes PD, Wildsmith JA. Spinal anaesthesia for elective surgery: a comparison of hyperbaric solutions of racemic bupivacaine, levobupivacaine, and ropivacaine. Br J Anaesth. 2008;101(5):705-10.

Üstüner A, Eren N, Karabağ G, Başaran H, Topuz C, Özyuvacı E. Comparison of the effects of intrathecal levobupicaine and isobaric bupivacaine in providing anesthesia in orthopedic surgical interventions. Turk J Anaesthesiol Reanim. 2008;36(6):346-50.

Kocamanoglu I, Sarıhasan B, Local Anesthetics: A New Agent, Levobupivacaine. J Exp Clin Med. 2007;24(1):27-36.

Erdine S. Regional Anesthesia. 1th ed. İstanbul: Nobel Publications; 2005:159-79.

Kim SY, Cho JE, Hong JY, Koo BN, Kim JM, Kil HK. Comparison of intrathecal fentanyl and sufentanil in low-dose dilute bupivacaine spinal anaesthesia for transurethral prostatectomy. Br J Anaesth. 2009;103(5):750-4.

Erturk E, Tutuncu C, Eroglu A, Gokben M. Clinical comparison of 12mg ropivacaine and 8 mg bupivacaine, both with 20 microg fentanyl, in spinal anaesthesia for major orthopaedic surgery in geriatric patients. Med Princ Pract. 2010;19(2):142-7.

Veering BT, Ter Riet PM, Burm AG, Stienstra R, Van Kleef JW. Spinal anaesthesia with 0.5% hyperbaric bupivacaine in elderly patients: effect of site of injection on spread of analgesia. Br J Anaesth. 1996;77(3):343-6.

De Santiago J, Santos-Yglesias J, Giron J, Montes de Oca F, Jimenez A, Diaz P. Low-dose 3 mg levobupivacaine plus 10 microg fentanyl selective spinal anesthesia for gynecological outpatient laparoscopy. Anesth Analg. 2009;109(5):1456-61.

Lee YY, Muchhal K, Chan CK. Levobupivacaine versus racemic bupivacaine in spinal anaesthesia for urological surgery. Anaesth Intensive Care. 2003;31(6):637-41.

Gautier P, De Kock M, Huberty L, Demir T, Izydorczic M, Vanderick B. Comparison of the effects of intrathecal ropivacaine, levobupivacaine, and bupivacaine for Caesarean section. Br J Anaesth. 2003;91(5):684-9.

Van de Velde M, Dreelinck R, Dubois J, Kumar A, Deprest J, Lewi L, Vandermeersch E. Determination of the full dose-response relation of intrathecal bupi vacaine, levobupivacaine, and ropivacaine, combined with sufentanil, for labor analgesia. Anesthesiol. 2007;106(1):149-56.

Bidikar M, Mudakanagoudar MS, Santhosh MC. Comparison of intrathecal levobupivacaine and levobupivacaine plus fentanyl for cesarean section. Anesthesia, Essays Researches. 2017 Apr;11(2):495.

Burke D. A comparison of vasoactivity between levobupivacaine and bupivacaine. Br J Anaesth. 1998;81:631-2.

Newton DJ, McLeod GA, Khan F, Belch JJ. Vasoactive characteristics of bupivacaine and levobupivacaine with and without adjuvant epinephrine in peripheral human skin. Br J Anaesth. 2005 May;94(5):662-7.

Hocking G, Wildsmith JA. Intrathecal drug spread. Br J Anaesth. 2004 Oct;93(4):568-78.

Hatun M, Arslan G, Temizel F, Erkal H, Süslü H, Özyurt Y, et al. The effects of addition of fentanyl or morphine to levobupivacaine in spinal anesthesia for cesarean section. J Kartal TR. 2013;24(2):73-81.

Belzarena SD. Clinical effects of intrathecally administered fentanyl in patients undergoing cesarean section. Anesth Analg. 1992 May;74(5):653-7.

Gaiser RR, Cheek TG, Gutsche BB. Comparison of three different doses of intrathecal fentanyl and sufentanil for labor analgesia. J Clin Anesth. 1998;10(6):488-93.




How to Cite

özdemir, A., & Çolak, M. S. (2019). Use of a local anesthetic and opioid combination in spinal anesthesia in short urologic surgeries. International Journal of Research in Medical Sciences, 7(2), 351–356.



Original Research Articles