Efficacy and Safety of Caudal Epidural Block in High-Risk Patients Undergoing Transurethral Resection of the Prostate in 70-Cases – A Prospective Study

Open Access

Abstract

Background: Transurethral resection of the prostate (TURP) remains the standard surgical treatment for symptomatic benign prostatic hyperplasia (BPH). Many candidates for TURP are elderly and burdened with comorbidities such as hypertension, diabetes, ischemic heart disease, and COPD, making anesthetic selection critical. Caudal epidural block (CEB) has resurfaced as a potential alternative for high-risk patients due to its hemodynamic stability and reduced neuraxial complications. Objectives: To evaluate the efficacy, safety, and hemodynamic profile of CEB in patients with comorbidities undergoing TURP. Methods & Materials: This prospective observational study included 70 high-risk patients (ASA II–III) scheduled for TURP. CEB was administered using a standardized technique with 1.5% lignocaine with adrenaline. Hemodynamic variables, block characteristics, intraoperative events, surgeon satisfaction, and postoperative outcomes were recorded. Exclusion criteria included coagulopathy, sepsis, prior spinal surgery, and inability to identify sacral hiatus. Results: CEB was successfully performed in 67 out of 70 patients (95.7%). Adequate surgical anesthesia was achieved in 61 patients (87.1%), whereas 6 required supplemental analgesia or conversion to general anesthesia. Hemodynamic parameters remained stable in the majority, with only 8.5% experiencing transient hypotension. Minor complications included urinary retention (7.1%), postoperative shivering (5.7%), and perineal discomfort at injection site (4.2%). No patient developed significant arrhythmias, TURP syndrome, or airway compromise. Surgeon satisfaction was high (85%), with optimal relaxation and minimal patient movement reported. Conclusion: CEB is a safe and effective anesthetic technique for TURP in patients with significant comorbidities, offering excellent hemodynamic stability and a favorable safety profile. It provides a valuable alternative to spinal anesthesia or general anesthesia in the elderly and medically fragile population.