Discussion
pruritus, kidney stones, pain
KIDNEY STONE, COMPLICATIONS
Spinal anesthesia is widely recognized as a safe and commonly employed technique for transurethral lithotripsy. Lower doses of intrathecal bupivacaine caused a reduction in the number of blocked dermatomes, and the duration of SA was reported. The co-administration of other adjuvant drugs can reduce the required bupivacaine dose and improve the quality of SA [While 74% of the study participants were male, no significant gender-based differences in statistical outcomes were observed between the two groups. However, the results suggest a potentially higher prevalence of kidney stones in men than expected. This discrepancy in the gender distribution of TUL candidates was also observed in a study by UludağThe sensory characteristics observed with bupivacaine alone or combined with intrathecal fentanyl revealed similar results. However, adding fentanyl to bupivacaine significantly increased SBL without increasing the recovery room discharge. The duration of the sensory block was 71.11±11.79 minutes in group A, but after adding fentanyl, this time increased to 86.11±17.77 minutes (group B) (p<0.001). Shahverdi The overall mean duration of surgery was 49.44±14.46 minutes, and the two groups were not significantly different in this regard. This is similar to the mean operative time reported in a study by Uygulanan Postoperative pain intensity, assessed by VAS score, was reported between 0 and 1 in both groups. Similarly, the level of sedation, as indicated by the RSS score, was consistently within the range of 1 to 2 in both groups. Additionally, the degree of motor block, assessed using the modified Bromage Score, was identical in both groups, with a score of 2.92±0.26. This score signifies that patients had limited or no movement in their lower limbs, including the pelvis, knees, and ankles, with a score of 3 indicating complete immobility and a score of 2 indicating limited ankle movement. These results are consistent with the findings of Atallah The results of the present study confirmed that the addition of fentanyl to low-dose bupivacaine increased the success rate (stone-free rate) of TUL as complete stone-free status was achieved in 100% of the patients in group B, which was marginally insignificant (p=0.051). Many studies compared the stone-free rate in different anesthesia methods used in urologic surgeries [Some studies reported that the most common side-effect following intrathecal administration of fentanyl was pruritus [The strength of this study lies in its pioneering approach to spinal anesthesia for TUL, demonstrating the safety of using intrathecal opium in SA. The main limitation of this study is being monocentric. Therefore, it is recommended that future research with larger sample sizes consider assessing surgical techniques and patient characteristics alongside the anesthetic approach to gain a more comprehensive understanding of the factors contributing to complications.