A comparison of spinal anesthesia with small-dose lidocaine and general anesthesia with fentanyl and propofol for ambulatory prostate biopsy procedures in elderly patients

Study ObjectiveTo compare operating conditions, intraoperative adverse events, recovery profiles, postoperative adverse effects, patient satisfaction, and costs of small-dose lidocaine spinal anesthesia with those of general anesthesia using fentanyl and propofol for elderly outpatient prostate biopsy.DesignProspective, randomized, blind study.SettingOutpatient anesthesia unit at a municipal hospital.Patients80 ASA physical status I and II patients, aged 65 to 80 years, scheduled for outpatient prostate biopsy.InterventionsPatients were assigned to receive either spinal anesthesia with 10 mg of hyperbaric 1% lidocaine (L group, n = 40) or anesthetic induction with fentanyl 1 μg · kg−1 IV and 1.0 mg · kg−1 propofol injected at 90 mg · kg−1 · h−1, followed by continuous infusion at 6 mg · kg−1 · h−1 (F/P group, n = 40).Measurements and Main ResultsBoth anesthetic techniques provided acceptable operating conditions for the surgeon. However, a significantly higher frequency of intraoperative hypotension was found in the F/P group than in the L group (P < 0.05). Time to home readiness was shorter in the F/P group (P < 0.05). Both techniques had no major postoperative adverse effects and resulted in a high rate of patient satisfaction. Total costs were significantly lower in the L group than in the F/P group (P < 0.01).ConclusionsSpinal anesthesia with 10 mg of hyperbaric 1% lidocaine may be a more suitable alternative to general anesthesia with fentanyl and propofol for ambulatory elderly prostate biopsy in terms of safety and costs.