Spinal versus epidural anesthesia for vesicovaginal fistula repair surgery in a rural sub-Saharan African setting.

STUDY OBJECTIVE To compare spinal anesthesia with epidural anesthesia in patients undergoing surgery for vesicovaginal fistula (VVF) repair. DESIGN Nonrandomized, prospective, clinical, pilot study. SETTING Rural African hospital with 165 beds. PATIENTS 60 ASA physical status I and II patients undergoing VVF repair surgery. INTERVENTIONS 30 patients were included in each study group. Spinal (1.5-2 mL hyperbaric bupivacaine 0.75%) or lumbar epidural (20-24 mL bupivacaine 0.5%) anesthesia was administered to the patients. MEASUREMENTS Demographics, quality of anesthesia, duration of postoperative analgesia, as well as preoperative, intraoperative, and postoperative data, were all recorded. Data were compared between study groups using unpaired Student's t test for continuous variables and chi(2) and Fisher's exact tests for categorical data. MAIN RESULTS Quality of anesthesia was different between groups (P = 0.009). Good anesthesia quality was significantly more frequent in the spinal (86.7%) than the epidural group (50%, P = 0.005). Postoperative analgesia quality was comparable (P = 0.347). There were no differences between groups in hemodynamic parameters before, during, or after surgery. CONCLUSION Spinal anesthesia proved to be the better anesthetic technique for VVF repair surgery when compared with epidural anesthesia in a rural, sub-Saharan African setting.