Intrathecal isobaric versus hyperbaric 0.5% levobupivacaine in turp surgeries: A narrative review

Background

Transurethral resection of the prostate (TURP) is usually performed in elderly men with significant cardiovascular and respiratory comorbidities. Spinal anaesthesia is often preferred because it facilitates early detection of complications such as fluid overload and TURP syndrome and avoids airway manipulation in high-risk patients [1]. Levobupivacaine, the S-enantiomer of bupivacaine, provides long-acting neuraxial anaesthesia with a more favourable cardiovascular and central nervous system safety profile than racemic bupivacaine, making it attractive in this population [2]. However, there is ongoing debate about whether isobaric or hyperbaric 0.5% levobupivacaine offers the best balance between block reliability, haemodynamic stability and recovery characteristics in TURP.