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Background and Aims Benign prostatic hypertrophy (BPH) is common in men over 50. Thulium Laser Enucleation of the Prostate (ThuLEP) is a minimally invasive technique for treating BPH. A disadvantage of ThuLEP is the length of the procedure, which requires appropriate anesthesia. Continuous Spinal Anesthesia (CSA) offers hemodynamic stability and unlimited time under anesthesia by use of intermittent boluses or by pump infusion. The aim of the study is to compare the two techniques.

Methods A retrospective study was conducted in patients undergoing ThuLEP between January 2023 and March 2024. Patients were divided into two groups CSA-B, (N =12) and CSA-I, (N=8) who received intermittent boluses or pump infusion. The average age of the patients was 70 years, ASA class (II - IV). Intralong CSA catheter (Pajunk, GmbH) 25, 27 G was placed at L3-L4, L2-L3. In both groups an initial dose of 1 to 1.7 ml of Bupivacaine 0.5% was administered, followed by boluses of 0.3 - 0.5 ml of 0.5% Bupivacaine in CSA-B or anesthetic infusion with 0.7 to 1.0 ml/hour in CSA-I. Some patients were also sedated.

Results A significant difference was found in the duration of anesthesia (p=0.0365) and a non-significant difference in the total amount of local anesthetic (p=0.06) and hemodynamic complications (p=0.47) in both groups. Correlations between complications - duration and complications - total amount of anesthetic are inverse. The dose-duration correlation is directly proportional.

Conclusions CSA provides hemodynamic stability through both techniques of anesthetic administration in patients undergoing ThuLEP. The infusion technique is preferred for a longer procedure.