Dural Puncture Epidural Anesthesia versus Traditional Spinal Anesthesia for Rigid Cystoscopy: A Randomized Controlled Trial

Neuraxial anesthesia is the gold standard for urological operations. Hence, this study examined whether dural puncture epidural (DPE) anesthesia provides better pain reduction than traditional spinal anesthesia (SP) during rigid cystoscopy.

This study set out to evaluate if DPE anesthesia offers improvement in pain relief compared to traditional SP for rigid cystoscopy.

This randomized controlled trial included 76 adults of both genders undergoing elective rigid cystoscopy. The participants were randomly divided into two equal-sized groups. Group SP received 3 ml of hyperbaric bupivacaine (0.5%0 and 25 mcg of fentanyl (0.5 ml). Group DPE received a 15-ml mixture of bupivacaine (0.25%) and 50 mcg of fentanyl over 5 minutes.

The time to first request rescue analgesia was delayed in group DPE compared to group SP.

The Group SP showed faster sensory block than the Group DPE. The Group DPE exhibited longer sensory and motor blocks than SP. Pain score, number of patients who required rescue analgesia, and total dose of morphine consumption in the first 24 hours were significantly lower in group DPE than in group SP. Mean arterial pressure (MAP) was significantly lower at 5min, 10min, and 15min in group SP than in group DPE.

DPE provides superior analgesia than SP as it offers prolonged duration sensory and motor block, better pain control, lower need for rescue analgesia, and better hemodynamic stability; however, SP has a rapid onset of sensory block.