Comparison of effectiveness and safety of spinal anaesthesia with 0.25% versus 0.5% hyperbaric bupivacaine for endoscopic urological procedures: A prospective randomised controlled trial
In brief
Half-dose spinal bupivacaine shortens recovery and stabilizes blood pressure
In a double-blind trial of 60 outpatients, 5 mg of 0.25% hyperbaric bupivacaine provided adequate anesthesia while producing fewer blood-pressure fluctuations, earlier walking and a shorter post-anaesthesia care unit stay than 10 mg of 0.5% bupivacaine. The higher dose gave slightly lower pain scores at two hours, but the trade-off favored the lower dose for ambulatory urologic surgery.
- Journal
- Indian journal of anaesthesia (Q2)
- Published
- 21 July 2026
- Study design
- Randomized controlled trial
- Evidence level
- Level 1, High (CEBM 1b)
- Authors
- Anil K Verma, Neha Mishra, Avijit Kumar
- PMID
- 42500635
- DOI
- 10.4103/ija.ija_282_26
Why clinicians should know about it
- Picked for Urology (paper of the day, 26 July 2026): Low‑dose bupivacaine improves hemodynamics and recovery in endoscopic urology
Abstract
BACKGROUND AND AIMS: Spinal anaesthesia is an effective alternative technique for short-duration endoscopic urological procedures. Conventional 0.5% hyperbaric bupivacaine may be associated with prolonged motor blockade and haemodynamic instability, potentially delaying ambulation and discharge. This study aimed to compare the efficacy and safety of 0.25% and 0.5% hyperbaric bupivacaine for spinal anaesthesia in ambulatory endoscopic urological procedures. METHODS: In this prospective, randomised, double-blind controlled study, 60 patients with American Society of Anesthesiologists physical status I and II undergoing elective lower urological endoscopic procedures were allocated into two groups (n = 30 each). Group A received 5 mg of 0.25% hyperbaric bupivacaine (2 mL), and Group B received 10 mg of 0.5% hyperbaric bupivacaine (2 mL) intrathecally. The primary outcomes were onset and duration of sensory and motor block. Secondary outcomes included haemodynamic changes, postoperative pain assessed using the visual analogue scale (VAS), time to ambulation, and duration of stay in the post-anaesthesia care unit. RESULTS: The onset of sensory block was faster and the duration of sensory and motor block was significantly longer in Group B (P < 0.001). The ambulation time and post-anaesthesia care unit stay were significantly prolonged in Group B (P < 0.001). Haemodynamic fluctuations were more frequent with 0.5% bupivacaine. Post-operative pain scores at 2 h were lower in Group B (P < 0.001). CONCLUSION: Low-dose 0.25% hyperbaric bupivacaine provides effective spinal anaesthesia with improved haemodynamic stability, earlier ambulation, and faster recovery compared to 0.5% hyperbaric bupivacaine, making it suitable for ambulatory endoscopic urological procedures.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.