Effect of bolus and fractional lidocaine administration in epidural anesthesia on quality of anesthesia and hemodynamic response in patients with risk

In the present study, a comparison of bolus and fractional EA was planned to obtain a better hemodynamic stability and to spread over time and minimize probable hemodynamic negativities in risky patients.Eighty patients to have TUR-P surgery due to benign prostat hypertrophy withe the age of 50 and older, who are in Goldman cardiac risk index Class II or above, diagnosed with Chronic Obstructive Pulmonary Disease (COPD) based on GOLD criteria, with non-regulated hypertension and diabetes mellitus and those physically in ASA III- IV group. Patients were divided into two groups according to EF value of >50 <50. Twenty patients with EF value of >50 and 20 with <50 were administered with 2% lidocain either as bolus or fractional.In all groups, at 5., 10., 15., 20., 25., 30., 35., 40., 45., 50., 60., 90. and 120. minutes post- administration, sensorial blockage level was measured by Pinprick test, degree of motor blockade was measured with Bromega scala. Also, at the same time points systolic and diastolic blood pressures, heart rate, CVP, peripheral oxygen saturation were examined. Time of increasing of sensory blockade to T10, maximum sensory block levels, time for regression of sensory block for two segments and complications were recorded.Results of the study showed that fractional EA method provided a beter hemodynamic balance than bolus method and this difference was statistically significant. In fractional EA adminestered groups, time of increasing of sensory blockade to T10 and time for regression of sensory block for two segments were found to be longer while maximum sensory bolck levels and sensory block levels were found to be lower.In conclusion, compared to bolus method, fractional EA method achieved a beter hemodynamic stability and longer motor blackade, but bolus method has a shorter time for anesthetic effect to begin. It was concluded that fractional EA would be a safer method in risky patients with limited physiological adaptation.Keywords: epidural anesthesia, fractional, bolus, hemodynamics