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Background and Aims Despite the benefits of spinal anesthesia and the desire of anesthesiologists to perform it, due to the proximity of stone place in ureter and the possibility of pain, restlessness and occasional movements of the patient during surgery, it is less accepted by urologists. This study aimed to compare the effect of low-dose bupivacaine plus fentanyl administered intrathecally in patients undergoing transurethral lithotripsy (TUL).

Methods In this randomized, double-blinded clinical trial, from April 2021 to September 2021, 54 patients with proximal ureteral stones candidates for TUL, were enrolled. Patients were randomly divided into two groups; group A received bupivacaine 10mg with 0.5ml of normal saline and group B received bupivacaine 10mg plus 0.5ml (25μg) of intrathecal fentanyl.

Results The mean age was 66.14±22.46 years and 74% were male. The total duration of surgery was 49.44±14.46 minutes. Sensory block was adequate for surgery in all patients. The sensory block onset time, sensory block level, pain score, degree of relaxation, depth of motor block, occurrence of anesthesia complications, oxygen saturation and mean arterial blood pressure were not significantly different in two groups. However, the duration of motor block in the group B was longer than group A (P<0.0001). In addition, retropulsion was observed only in 5(18.5%) patients in the group A which in compare to group B was significantly higher (P=0.019).

Conclusions Low-dose bupivacaine with fentanyl 25μg provides adequate spinal anesthesia with lower retropulsion in patients with nephrolithiasis who are candidate for TUL.