Comparison of Saddle Block and Subarachnoid Block for Transurethral Resection of The Prostate in Elderly Cardiac Patients: A Randomized Clinical Trial

Background: Transurethral resection of the prostate (TURP) commonly utilizes spinal anesthesia, but this method can pose risks, particularly hypotension. Saddle block, a variation of spinal anesthesia, targets the pelvic region and sacral nerve roots, potentially reducing hemodynamic disturbances.
Aim: To compare the hemodynamic effects and surgical adequacy of saddle block versus subarachnoid block for TURP in elderly cardiac cases. Patients and Methods: A total of sixty cases aged 60 and older with American Society of Anaesthesiologists III classification scheduled for TURP. They were randomly allocated into 2 groups of 30 patients each. Group I had subarachnoid block with 2 ml of levobupivacaine. Two millilitres of levobupivacaine were administered to Group II along with saddle block.  Baseline and subsequent measurements for oxygen saturation, heart rate, diastolic, systolic, and mean arterial pressures have been recorded. Block levels were assessed, and ephedrine was administered as needed to manage hypotension. The total amount of vasopressors used was documented. Complications were monitored throughout.
Results: Group II (saddle block) exhibited a significantly lower incidence of hypotension compared to Group I (subarachnoid block) and required fewer vasopressors (P < 0.05). Both groups achieved adequate surgical conditions. No cases of volume overload, TURP syndrome, or bladder perforation were observed in either group.
Conclusion: Saddle block provides a safer alternative to subarachnoid block for TURP in elderly cardiac patients, offering reduced incidence of hypotension and decreased need for vasopressors, while maintaining adequate surgical conditions and avoiding major complications.