Evaluation of hypotensive prevention effect of intramuscular glycopyrrolate in spinal anaesthesia of elderly TURP patients: A randomized control trial

Abstract

Objective: Spinal anaesthesia is one of the options for patients who need transurethral resection of the prostate (TURP). However, due to typical patient age, risk factors, and the procedure itself, hemodynamic instability is common and hazardous. Glycopyrrolate, an anticholinergic drug, has been used in many indications, including in hypotensive prevention in caesarean section patients undergoing spinal anaesthesia. The study aims to evaluate the hypotensive prevention effect of the drug in elderly (> 60 years) spinal anaesthesia TURP patients. Methods: A prospective randomized control trial of 62 elderly patients who needed TURP was conducted from December 2019 to January 2020. Exclusion criteria were an American Society of Anesthesiologists classification of more than three, contra-indication for glycopyrrolates, and an inability to take spinal anaesthesia. The primary testing process was administration of 0.2 milligram (mg) intramuscular glycopyrrolate 15 minutes before spinal anaesthesia. Data were collected concurrently with hemodynamic parameters, which were recorded as a baseline and every 5 minutes up to 60 minutes. The analysis was done with both single-measure and repeated-measures analysis. Results: Hypotensive incidence was significantly reduced in the glycopyrrolate group (38.7 vs. 74.2%, p-value=0.01) and showed significantly decreased use of epinephrine [0.2 (±1.1) vs. 4.55 (±6.0) mg, p-value<0.01). Intravenous fluid and vasopressor requirements were also lower. All hemodynamic parameters were higher in the glycopyrrolate group, except heart rate. Conclusion: Intramuscular glycopyrrolate could prevent spinal anaesthesia-related hypotension without a difference in heart rate in elderly TURP patients.