COMPARISON OF MOTOR BLOCK ONSET, SENSORY BLOCK, HEMODYNAMIC CHANGES, SIDE EFFECT OCCURRENCE, AND RECOVERY TIME BETWEEN 2% HYPERBARIC PRILOCAINE SPINAL ANESTHESIA COMPARED TO 5% HYPERBARIC LIDOCAINE IN UROLOGICAL SURGERY

Abstract

Objectives: Spinal anesthesia is an anesthesia technique to facilitate lower abdominal, gynecological, lower extremity and urological surgeries. Lidocaine and prilocaine are local anesthetics that have a rapid onset and intermediate duration of action that are well used as spinal anesthesia for short operations. Prilocaine is a new drug introduced in Indonesia since 2022. The purpose of this study was to analyze the effectiveness and incidence of side effects of spinal anesthesia with 2% hyperbaric prilocaine compared to 5% hyperbaric lidocaine in urological surgery at Dr. Soetomo General Hospital.

Methods: Analytical study, experimental single blind randomized control trial. Total of 40 subjects aged 18-65 years, PS ASA I-II who underwent urological surgery under spinal anesthesia were involved in this study, which were randomly divided into two groups group A which received 75 mg of 5% hyperbaric lidocaine and group B which received 60 mg of 2% hyperbaric prilocaine.  There were 2 subjects from each group who experienced block failure. Subjects involved in this study were monitored for vital signs before and during surgery, measurement of motor block onset, block height, adverse events and motor recovery time after spinal anesthesia.

Results: There were no significant differences in motor block onset, sensory block height, systolic blood pressure changes, diastolic blood pressure changes, incidence of side effects of bradycardia, shivering, IONV, TNS, block failure and motor recovery time after spinal anesthesia in both groups. In statistical tests using the t test, there was a significant difference in MAP changes (prilocaine group 13.53 ± 7.98 vs 19.84 ± 9.668 lidocaine group p 0.035) and chi square test on the incidence of hypotension obtained a significant difference (prilocaine group 3 (15.7%) vs 9 (47.3%) in the lidocaine group p 0.036).

Conclusion: While the onset of motor block, sensory block height, systolic and diastolic blood pressure, and heart rate did not significantly differ between the two groups, the change in mean arterial pressure (MAP) was lower in the prilocaine group compared to the lidocaine group. The incidence of hypotensive side effects was also lower in the prilocaine group. Both groups experienced side effects of bradycardia, shivering, and IONV, but TNS was only reported in the lidocaine group, with no significant difference between the groups. Motor block recovery time in the prilocaine group was longer than in the lidocaine group but not statistically significantly different.