Эффективность 2% гипербарического раствора прилокаина и 0,5% гипербарического раствора бупивакаина при спинальной анестезии в урологической эндоскопической хирургии

In the field of modern medical practice, urological endoscopy is pivotal for the diagnosis and treatment of various urological conditions, offering a minimally invasive alternative to conventional surgery. This method significantly reduces recovery times and complications, underscoring its critical role in contemporary medicine [1—4]. Diagnostic urological endoscopy, performed as an outpatient surgical procedure, emphasizes the importance of anesthesia techniques that allow for rapid patient discharge. Local anesthesia is commonly used despite its unpredictability and potential discomfort for patients. Selective spinal anesthesia with short-acting hyperbaric local anesthetic agents offers a solution by ensuring rapid sensory and motor block, predictable duration, and low side-effect incidence. Spinal anesthesia is highly reliable, providing effective analgesia with minimal side effects, quick turnover time, and low cost, making it highly suitable for urological endoscopy procedures [5, 6]. The efficacy of these procedures, especially in outpatient settings, hinges significantly on the anesthesia employed. A pivotal transition, as Munro & Uppal [7] elucidate, has been from traditional local anesthesia to advanced techniques like selective spinal anesthesia using short-duration hyperbaric local anesthetics. This advancement is notable for its combination of reliability, effective pain relief, minimal side effects, and cost-effectiveness, making it increasingly preferred in urological endoscopy due to its profound influence on patient recovery and procedural efficiency.

Dating back to 1885, spinal anesthesia has undergone substantial developments, now encompassing surgeries of the lower abdomen, perineum, and lower extremities. Yaksh & Hayek, [9] provide a comprehensive historical overview of spinal anesthesia’s evolution, noting its application through both epidural and spinal routes. The administration of local anesthetics into the subarachnoid space for targeted analgesia at specific dermatome levels is a key aspect of this technique. The selection of appropriate candidates for spinal anesthesia necessitates an in-depth understanding of patient-specific conditions and the dynamics of anesthetic agents, as expounded by [10].

In urological endoscopy, the precise application of spinal anesthesia is vital for effective pain management and minimizing physiological stress on patients. Li et al. [12] emphasize the significance of patient stability and comfort in minimally invasive urological techniques, underscoring the necessity for carefully tailored anesthesia strategies. The use of traditional anesthetics like lidocaine and bupivacaine has encountered challenges in clinical practice. Lidocaine’s association with transient neurological symptoms post-intrathecal administration has resulted in its decreased usage. On the other hand, bupivacaine, although less associated with TNS, presents cardiotoxic risks and postoperative urinary retention concerns. These challenges necessitate the exploration of safer, more efficacious anesthetic alternatives in urological procedures, as discussed by [13].

The FDA’s 2020 endorsement of prilocaine for short-duration spinal anesthesia signifies a major advancement. Known for its rapid onset and moderate potency, prilocaine, a member of the amino-amide local anesthetics class, offers several advantages, including lower systemic toxicity and hemodynamic disturbances. Its usage, however, demands careful dosage adjustments, as Cismasiu et al. [1] highlight in their study on optimizing anesthesia management across various surgical contexts.

Recent research has focused on comparing hyperbaric bupivacaine and prilocaine in outpatient surgeries. Koo et al. [2], Radkowski et al. [3] delve into the neurological implications of general anesthesia, providing relevant insights into the effects of different anesthetic agents in varied surgical settings. Despite prilocaine’s growing preference, a research gap persists in its application in urological endoscopy, particularly beyond TURB procedures. This study seeks to bridge this gap by comparing the efficacy of 2% hyperbaric prilocaine and 0.5% hyperbaric bupivacaine in such surgeries. Our research is poised to significantly impact the scientific community and medical practitioners, enriching the knowledge base on spinal anesthetics and influencing future anesthesia policies and guidelines in urological endoscopy.

Spinal anesthesia plays a pivotal role in urological surgeries, involving the injection of anesthetics into the subarachnoid space. Several studies [4—6] discuss the effectiveness and physiological impacts of various spinal anesthesia techniques, emphasizing their crucial role in contemporary surgical practices. The technique’s ability to enhance patient comfort and reduce stress during surgeries is also highlighted in these studies.

Recent studies comparing prilocaine and bupivacaine in spinal anesthesia highlight prilocaine’s shorter motor block duration and faster recovery times, making it a preferred choice in various surgical settings. Further, [7, 8] found prilocaine to be more effective for rapid post-operative recovery in elective caesarean sections. In urological surgeries, [9, 10] demonstrated prilocaine’s suitability due to its shorter motor block, enhancing patient comfort and facilitating quicker recovery. Kamal et al. [11] supported these findings, indicating prilocaine’s effectiveness in lower abdominal surgeries. Ambrosoli et al. [12] further confirmed prilocaine’s advantages in day-case surgeries due to its rapid regression of motor and sensory blocks, essential for ambulatory surgeries. These studies collectively suggest prilocaine as a more efficient anesthetic in surgeries where reduced motor block duration and quick recovery are crucial.

Prilocaine and bupivacaine are commonly used local anesthetics in spinal anesthesia. Tantri et al. [10] conducted a study comparing these agents in urological surgeries, noting differences in recovery times and effectiveness. Additionally, Amr et al. [9] compared the duration and efficacy of prilocaine-dexmedetomidine and bupivacaine-dexmedetomidine in spinal anesthesia for inguinal hernia repair, offering valuable insights into their relative performances.

Recent studies highlight the efficacy of hyperbaric 2% prilocaine over 0.5% hyperbaric bupivacaine in spinal anesthesia. Further, [7, 13, 14, 15] showed that prilocaine maintains the T12 analgesic level for a shorter duration and has faster motor block regression and time to spontaneous urination compared to bupivacaine. This makes prilocaine a viable option for lower extremity surgeries [24]. Etriki et al. [14] further supported these findings in day-case surgeries, demonstrating prilocaine’s faster onset and quicker recovery, which is advantageous for outpatient surgeries. Kaban et al. [16] found similar results in same-day perianal surgeries, where prilocaine facilitated earlier sensory block resolution and discharge readiness. Cannata et al., 2014 observed prilocaine’s rapid onset and shorter block duration in transurethral bladder resections, with fewer side effects like hypotension and bradycardia. Further, [7, 8] have confirmed these outcomes in elective caesarean sections and various surgical settings, citing prilocaine’s shorter motor block and recovery time [7, 8]. Additionally, Boublik et al. [17] highlighted prilocaine’s appropriateness for low-dose spinal anesthesia in ambulatory surgeries.

These comprehensive studies collectively underline hyperbaric prilocaine’s advantages, such as its rapid onset, shorter duration, and reduced side effects, making it suitable for diverse surgical procedures requiring quick patient recovery.

This study employed a comprehensive randomized controlled trial design, meticulously focusing on patients scheduled for short-duration urologic endoscopy. The participant selection was guided by stringent inclusion and exclusion criteria, tailored to the specific requirements of urologic endoscopic procedures. Upon obtaining ethical clearance from the institutional review board and ensuring informed consent from all participants, subjects were methodically assigned to either the 2% hyperbaric prilocaine group or the 0.5% hyperbaric bupivacaine group for spinal anesthesia. Participant selection was meticulously strategized using a stratified random sampling approach. This method ensured a representative cross-section of the patient population undergoing short-duration urologic endoscopy. Criteria for inclusion were carefully delineated, encompassing age, health status, and specific medical histories pertinent to the anesthesia types under study. Exclusion criteria were equally rigorous, excluding patients with contraindications to either anesthetic or those with complicating medical conditions. This judicious selection process, combined with stratified sampling, ensured a robust and representative sample, crucial for the validity and generalizability of our findings.

The population used in this study is all patients undergoing urology endoscopy procedures with spinal anesthesia at Wahidin Sudirohusodo Makassar Central General Hospital. The sample used in this study is patients undergoing urology endoscopy procedures with spinal anesthesia at Wahidin Sudirohusodo Makassar Central General Hospital who meet the inclusion criteria and agree to participate in the research taken by consecutive sampling method. The minimum sample size estimated can be calculated using the formula for the analysis of the mean comparison of two sample groups as follows:

Explanation:

n = Minimum sample size per group;

Zα = Type I error, set at 5% with a two-tailed hypothesis (1.96);

Zβ = Type II error set at 10% (1.28);

U2 = Onset of sensory block in the prilocaine group = 6.78;

U1 = Onset of sensory block in the bupivacaine group = 138;

σ = estimated standard deviation = 6.

Thus, the value of n in this study is:

n = (2·(1.96+1.28)²·6²)/(13—6.7)² = 19.04 (rounded to 20).

Based on the formula above, the minimum sample size per group is 20.

The inclusion criteria in this study are:

— Patients undergoing urology endoscopy procedures with spinal anesthesia;

— Age 18—60 years;

— ASA physical status I—II;

— Height 155—175 cm;

— Body Mass Index (BMI) 18.5—24.9 kg/m²;

— Agree to participate in the research.

The exclusion criteria in this study are:

— Patients undergoing transurethral resection of the prostate (TURP) and transurethral resection of bladder tumor (TURBT);

— Patients with absolute contraindications to spinal anesthesia;

— Patients with hypersensitivity to local amide anesthesia;

— Pregnant patients;

— Patients with psychiatric diseases;

— Patients who refuse to participate in the research.

The drop-out criteria in this study are:

— Procedure duration >90 minutes;

— Patients experiencing complications during the study;

— Patients withdrawing from the research.

Dropout management was an integral component, designed to address and mitigate participant withdrawal or loss to follow-up. Strategies to minimize dropout rates involved regular follow-up communications, flexible scheduling for assessments, and ensuring participant comfort and understanding of the study processes. In cases of dropout, a thorough review was conducted to understand the underlying reasons, and appropriate statistical methods were applied to handle the missing data, thus preserving the study’s integrity and the validity of its conclusions.

Before the research is conducted, the researcher requests ethical clearance from the Biomedical Research Ethics Commission on humans at the Faculty of Medicine, Hasanuddin University, and the Education and Research Department of Wahidin Sudirohusodo Makassar Central General Hospital. All patients meeting the inclusion criteria are given an oral explanation and sign a consent form to voluntarily participate in the research.

The study rigorously adhered to the principles of the Helsinki Declaration, emphasizing patient safety, confidentiality, and the right to withdrawal. Continuous monitoring and audits ensured adherence to these ethical standards.

Data collection was designed to be comprehensive and precise, encompassing not only the onset and duration of both sensory and motor blocks but also meticulously documenting any occurrences of side effects such as hypotension and bradycardia. Patient outcomes, including recovery times and subjective experiences, were systematically recorded, providing a holistic view of the procedural efficacy and safety. The data analysis was grounded in robust statistical methods tailored for comparative clinical studies.

The collected data was tabulated into Excel and then analyzed using SPSS 23 for Windows. Univariate analysis was performed by calculating the count, percentage, mean, median, and standard deviation of the research variables and patient characteristics. Bivariate tests were conducted to examine differences between two groups with numeric data distributions using the independent sample t-test when the data was normally distributed, and the Mann—Whitney U test for non-normally distributed data. Changes in numeric variables over time were analyzed with the Paired T test for normally distributed data, and the Wilcoxon Z test for non-normally distributed data. Normality of data was tested using the Shapiro-Wilk test. To examine differences among variables with all categorical data, the chi-square test was used (if no expected count value <5), but if any cell had an expected count value <5, then the Fisher-exact test was applied.

To succinctly illustrate the methodological framework of our study, a detailed flowchart delineating the entire process — from patient selection and randomization to anesthesia administration, data collection, and analysis — was developed. Furthermore, a comprehensive table was included to outline the statistical methods utilized, providing clarity and transparency to our analytical approach (fig. 1).

Fig. 1. Framework of the Research.

In our quest to expand the boundaries of knowledge within the realm of spinal anesthesia for urological endoscopy, this investigation meticulously compares the effectiveness of 2% hyperbaric prilocaine against 0.5% hyperbaric bupivacaine. The essence of our research is not merely academic; it harbors the potential to profoundly influence the scientific and medical communities. By enriching our collective understanding of spinal anesthetic agents, we aim to shape future anesthetic guidelines and practices, thereby enhancing patient care in urological surgeries. The characteristics of the study sample for both groups are presented in the table 1.

Table1. Sample Characteristics Based on Age, Gender, Body Mass Index, and Physical Status

Note. Gender data processed using Chi Square test, other variables using Mann—Whitney U Test; ^ns — not significant (homogeneous data).

According to table 1, the age group, gender, body mass index, and physical status were tested between the prilocaine and bupivacaine groups with results p>0.05, indicating both groups have homogeneous data suitable for comparison.

The comparison between sensory block onset and motor block onset in the prilocaine and bupivacaine groups is shown in the table 2.

Table2. Sensory and Motor Block Onset in Prilocaine and Bupivacaine Groups

Note. Data tested with Mann—Whitney U test; * — significant.

The comparative analysis of sensory block onset and motor block onset between prilocaine and bupivacaine groups, as delineated in table 2, elucidates noteworthy disparities in anesthesia onset times. Notably, significant differences were discerned in sensory block initiation, with prilocaine demonstrating a swifter onset (median: 3.0 minutes) compared to bupivacaine (median: 3.0 minutes), substantiated by a p-value of 0.007. Similarly, for motor block onset, prilocaine exhibited expedited initiation, manifesting a median onset time of 3.0 minutes, in contrast to bupivacaine’s median onset time of 4.0 minutes, a statistically significant finding (p<0.001). These findings underscore prilocaine’s superior efficacy in promptly achieving both sensory and motor blocks during spinal anesthesia. The differential onset rates are primarily attributed to the degree of ionization (pKa) of the local anesthetic agents, wherein prilocaine’s lower pKa of 7.7, closer to physiological pH, facilitates more rapid diffusion through nerve sheaths compared to bupivacaine’s pKa of 8.1.

Moreover, our study meticulously controlled for equipotent concentrations and doses of local anesthetics, thus mitigating their potential influence on onset variations. The consistent efficacy of prilocaine, particularly in facilitating faster onset times in outpatient spinal anesthesia procedures, is well-documented across various studies including [14, 18—20]. This advantage is largely attributable to prilocaine’s lower plasma protein binding, which expedites its action and reduces its duration compared to bupivacaine [21]. Etriki et al. [14] further highlight prilocaine’s benefit in outpatient settings due to its rapid recovery times. In similar settings, [18] observed that prilocaine resulted in shorter motor block durations and quicker recuperation of full motor function during urological endoscopy procedures.

In pediatric anesthesia, the challenge of detecting intravascular local anesthetic injection in heavily sedated or anesthetized patients underscores the need for a thorough understanding of the pharmacokinetics of anesthetics like prilocaine to ensure patient safety [8, 21]. Additionally, comparative studies by Ivani et al. [22] on ropivacaine and bupivacaine further elucidate the differential impacts of these anesthetics in pediatric surgical contexts. Furthermore, Goffard et al. [8] provided crucial insights into the use of hyperbaric prilocaine with sufentanil for cesarean deliveries, enhancing our understanding of its efficacy and safety profile in obstetrical anesthesia.

Ultimately, selecting an appropriate local anesthetic agent plays a critical role in optimizing outcomes for various procedures. Understanding the pharmacological properties and clinical implications of different anesthetics like Prilocaine and Bupivacaine is essential for patient care and successful anesthesia management.

The comparison of sensory and motor block duration between the Prilocaine and Bupivacaine groups is presented in the table 3.

Table3. Duration of Sensory and Motor Blocks in Both Groups

Note. Data tested with Mann—Whitney U Test; * — significant.

The comparison of sensory and motor block duration between the Prilocaine and Bupivacaine groups, as presented in table 3, reveals notable disparities in anesthesia duration. Prilocaine demonstrates significantly shorter durations for both sensory and motor blocks compared to Bupivacaine, with p-values indicating statistical significance (p<0.001). Specifically, the median duration of sensory block was 91.0 minutes for Prilocaine and notably longer at 188.5 minutes for Bupivacaine. Similarly, the median duration of motor block was 102.0 minutes for Prilocaine and considerably extended to 220.0 minutes for Bupivacaine.

The duration of sensory and motor blocks is influenced by various factors, including dose, physicochemical properties, and pharmacokinetics of the local anesthetics. Higher doses typically result in longer block durations, while drug characteristics such as plasma protein binding and metabolism also play significant roles. In the realm of anesthesia management, the choice of local anesthetics plays a pivotal role in determining the outcomes of various surgical procedures. Prilocaine, with its lower plasma protein binding compared to Bupivacaine, has been shown to offer advantages such as faster action and shorter duration. Etriki et al. [14] highlighted the benefits of Prilocaine for outpatient spinal anesthesia due to its faster recovery time compared to Bupivacaine, emphasizing its suitability for procedures where rapid recovery is essential. Similarly, Cannata et al. [18] demonstrated that Prilocaine led to shorter motor block durations and faster recovery of full motor function in urological endoscopy compared to Bupivacaine, further supporting the superiority of Prilocaine in certain surgical contexts. Expanding on the advantages of Prilocaine, Manassero & Fanelli [23] discussed that sensory and motor blockade recover sooner after Prilocaine spinal anesthesia, reinforcing its efficacy in achieving rapid recovery compared to other local anesthetics.

Additionally, Camponovo et al. [24] conducted a comparative study on different doses of hyperbaric Prilocaine for intrathecal anesthesia in ambulatory surgery, showing that the hyperbaric solution resulted in faster times to motor block onset and shorter duration of surgical block, indicating its suitability for outpatient settings. Furthermore, Tantri et al. [10] compared the recovery time after spinal anesthesia with hyperbaric Prilocaine and hyperbaric Bupivacaine for cystoscopic procedures, highlighting Prilocaine as a potential alternative with a shorter duration of action, which could be advantageous in certain surgical settings.

In summary, our results underscore Prilocaine’s superiority in achieving shorter durations for both sensory and motor blocks compared to Bupivacaine, with implications for optimizing anesthesia management in various surgical contexts, particularly in outpatient procedures where rapid recovery is paramount.

The comparison of mean arterial pressure between the prilocaine and bupivacaine groups can be seen in fig. 2.

Fig. 2. Changes in Mean Arterial Pressure.

The comparison of mean arterial pressure (MAP) between the Prilocaine and Bupivacaine groups, detailed in fig. 2, reveals significant differences at measurement times T1 and T2, indicating distinct hemodynamic responses between the two anesthesia agents. Notably, the Prilocaine group exhibited a more stable MAP profile compared to the Bupivacaine group, as illustrated in fig. 2, where a significant decrease in MAP was observed at T1 and T2 in the Bupivacaine group.

The observation of a steadier pulse rate profile in the Prilocaine group compared to the Bupivacaine group, without any instances of bradycardia despite no significant differences in pulse rate measurements, aligns with the findings of Costa et al. [13] and Tran et al. [25]. Further, Costa et al. [13] suggested that selective spinal anesthesia using Prilocaine could attenuate the extent of sympathetic block and mitigate hemodynamic impacts, emphasizing the potential benefits of Prilocaine in maintaining hemodynamic stability during spinal anesthesia.

Expanding on the hemodynamic effects of local anesthetics, investigated the impact of different vasoconstrictors and local anesthetic solutions on Substance P expression in human dental pulp, shedding light on the complex interactions between local anesthetics and neurochemical mediators in modulating vascular responses [26]. Additionally, Durand et al. [27] explored the mechanisms underlying current-induced vasodilation during water iontophoresis, highlighting the involvement of capsaicin-sensitive afferent fibers and aspirin-sensitive mechanisms, which could have implications for understanding the vascular effects of local anesthetics like Prilocaine. Moreover, Collins et al. [28] discussed the use of lipid emulsion in treating local anesthetic toxicity, emphasizing its role in managing postoperative complications and stabilizing hemodynamics in critical situations [28]. This underscores the importance of considering not only the anesthetic properties but also the potential systemic effects of local anesthetics in clinical practice.

In conclusion, the interplay between local anesthetics like Prilocaine and their effects on hemodynamics underscores the complexity of anesthesia management and the need for a comprehensive understanding of their pharmacological actions to optimize patient care and safety during surgical procedures.

The comparison of pulse rates between the Prilocaine and Bupivacaine groups can be seen in figure 3.

Fig. 3. Changes in Pulse Rate.

The observations from fig. 3 provide a compelling visual representation of the differential impact of Prilocaine and Bupivacaine on pulse rates over time. Here, we can delve deeper into the pharmacodynamics and potential clinical implications of these findings. The stability of the pulse rate in the Prilocaine group, as depicted in fig. 3, suggests that Prilocaine has a relatively modest impact on cardiovascular dynamics. Prilocaine’s unique pharmacokinetics, characterized by reduced vasodilation and rapid metabolism compared to Bupivacaine, lead to decreased systemic exposure [21]. This distinctive profile of Prilocaine has been linked to its chemical structure, enabling quick action and short duration, making it beneficial for maintaining cardiovascular stability during anesthesia [21].

Studies by Guthe et al. [29] have emphasized the vasodilator properties of Prilocaine, underlining its potential impact on local blood flow and tissue responses. Regarding dental procedures, research by Rishiraj et al. [30] has identified methemoglobinemia as a primary clinical concern associated with Prilocaine due to its metabolite o-toludine [30]. This safety issue highlights the importance of carefully assessing the potential adverse effects of Prilocaine in clinical practice. Additionally, Gazal [31] discussed Prilocaine’s metabolic pathways, noting its preferential metabolism in the liver compared to other local anesthetics like lidocaine or mepivacaine [31].

Furthermore, Wallace et al. (2010) compared the anesthesia depth and duration between heated lidocaine/tetracaine patches and placebo patches, showcasing the vasoconstrictive properties of lidocaine formulations compared to prilocaine-containing products like EMLA Cream (Wallace et al., 2010). This distinction in vascular effects underscores the significance of comprehending the specific attributes of different local anesthetics, such as Prilocaine, in clinical settings to enhance patient care and outcomes.

In conclusion, fig. 3 illustrates the significant contrast between the effects of Prilocaine and Bupivacaine on pulse rate, with Prilocaine exhibiting a more stable effect compared to the pronounced fluctuations associated with Bupivacaine. This visual analysis effectively underscores the nuanced considerations essential in the clinical application of local anesthetics, closely aligning with their pharmacological profiles. Prilocaine, in particular, is characterized by its reduced vasodilation, rapid metabolism, and specific safety considerations, underscoring its significant role in anesthesia management. The analysis highlights the importance of tailored approaches in anesthesia, considering the unique properties of each local anesthetic to optimize patient care and safety.

The incidence of side effects in the prilocaine and bupivacaine groups is shown in table 4.

Table4. Incidence of Side Effects in the Prilocaine Group and the Bupivacaine Group

Note. N (%) — the number and percentage of patients; ^ns — not significant; * — statistically significant differences.

Table 4 details the occurrence of side effects in patients receiving either prilocaine or bupivacaine for spinal anesthesia, highlighting the significant finding that hypotension was exclusively observed in the bupivacaine group (0% vs. 30%, p=0.008). In contrast, instances of shivering were slightly more common in the prilocaine group, although not statistically significant (35% vs. 20%, p=0.288^ns). The absence of side effects such as bradycardia, nausea, vomiting, and procedural pain across both groups underscores the overall safety of these anesthetic options for clinical use.

The efficacy of Prilocaine as an alternative in anesthesia management, particularly for procedures necessitating expedited recovery and minimized adverse effects, is supported by research conducted by [18, 23]. This study focused on the comparative analysis of 2% hyperbaric prilocaine versus 0.5% hyperbaric bupivacaine for spinal anesthesia in short-duration urologic endoscopies, revealing Prilocaine’s superior outcomes in terms of quicker onset and shorter duration of sensory and motor blocks, along with a reduced incidence of hypotension and bradycardia compared to Bupivacaine [23].

Further emphasizing the advantages of Prilocaine, [21, 23] highlighted the favorable anesthetic and safety profile of 2% hyperbaric Prilocaine, positioning it as a viable alternative to other local anesthetics for spinal anesthesia of intermediate or short duration. Additionally, [32] discussed the management of pain using lidocaine-prilocaine cream, emphasizing the absence of clinical signs of methemoglobinemia in infants, which is a notable safety consideration associated with Prilocaine. Moreover, [8] compared equipotent doses of intrathecal hyperbaric Prilocaine and hyperbaric Bupivacaine for elective caesarean section, highlighting the efficacy of hyperbaric Prilocaine in ambulatory surgery. This further supports the notion of Prilocaine as a valuable option in anesthesia practice, especially for procedures requiring rapid recovery and reduced cardiovascular side effects.

To summarize, the body of research highlights a comprehensive overview of spinal anesthesia’s evolution, highlighting its essential role in surgeries involving the lower abdomen, perineum, and lower extremities. Through detailed comparisons and clinical trials, the studies collectively underscore Prilocaine’s efficacy in ensuring faster recovery and fewer side effects. This body of evidence affirms Prilocaine’s potential as a preferred choice for a broad spectrum of surgical procedures due to its unique pharmacological properties, which contribute to improved patient outcomes and safety profiles.

In addressing the underexplored area of optimal anesthetic choice for short-duration urologic endoscopy, this study makes a significant contribution to the field of surgical anesthesia. We meticulously compared 2% hyperbaric prilocaine with 0.5% hyperbaric bupivacaine, revealing prilocaine’s enhanced efficacy in terms of quicker onset and shorter duration of sensory and motor blocks, coupled with a reduced frequency of side effects such as hypotension and bradycardia. This research brings to light the often-overlooked need for precision in anesthetic selection, especially in short-duration surgical procedures. The novelty of our study lies in its focus on prilocaine as a viable alternative to the more commonly used bupivacaine, challenging existing anesthetic norms and suggesting a shift towards more patient-centered anesthetic choices. Furthermore, our findings extend beyond the specific context of urologic endoscopy, proposing implications for a wide range of surgical specialties. This could catalyze a transformative approach in anesthesia, where the selection of agents is tailored not just to the procedural requirements but also to optimizing patient recovery and comfort. Therefore, this research is not only a step forward in improving surgical outcomes in urologic endoscopy but also serves as a catalyst for broader changes in surgical anesthesia practices. It invites ongoing research and clinical reevaluation, aiming to redefine anesthesia protocols for enhanced patient care across multiple surgical disciplines.