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This single-center prospective observational study investigates the effect of body mass index (BMI) on intraoperative vasopressor requirements and spinal block characteristics in adult patients undergoing urological surgery under spinal anesthesia. Participants are classified into two cohorts according to BMI (<27.5 kg/m² and ≥27.5 kg/m²).Patient enrollment for this prospective observational study started before trial registration; therefore, this record represents a retrospective registration.
This is a single-center prospective observational study conducted at a tertiary care hospital between May 2022 and December 2025. The study aims to evaluate the relationship between body mass index (BMI) and intraoperative ephedrine requirements, sensory and motor block characteristics, and hemodynamic responses in adult patients undergoing elective urologic surgery in the lithotomy position under spinal anesthesia. All patients received a standardized intrathecal dose of 3 mL 0.5% hyperbaric bupivacaine, and intraoperative hypotension was treated with intravenous ephedrine according to a predefined protocol. Patient enrollment for this prospective observational study began before registration of the study; therefore, this record represents a retrospective registration. Ethics approval was obtained from the institutional ethics committee prior to patient recruitment, and written informed consent was obtained from all participants.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| BMI <27.5 kg/m² (Group L) | Adult patients undergoing elective urologic surgery under spinal anesthesia with a body mass index (BMI) <27.5 kg/m² | ||
| BMI ≥27.5 kg/m² (Group H) | Adult patients undergoing elective urologic surgery under spinal anesthesia with a body mass index (BMI) ≥27.5 kg/m². |
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| Measure | Description | Time Frame |
|---|---|---|
| Intraoperative ephedrine consumption (mg) | Cumulative intravenous ephedrine dose administered to treat hypotension (systolic arterial pressure <90 mmHg or >30% decrease from baseline) from the time of spinal anesthesia induction until the end of the surgical procedure. | From spinal anesthesia induction until completion of surgery. |
| Measure | Description | Time Frame |
|---|---|---|
| Maximum sensory block level | Highest thoracic dermatome level reached after intrathecal injection of 3 mL 0.5% hyperbaric bupivacaine, assessed by pinprick testing every 2 minutes. | During intraoperative monitoring |
| Time to reach maximum sensory block (minutes) |
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Inclusion Criteria:
Exclusion Criteria:
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Adult patients (≥18 years) with ASA physical status I-II scheduled for elective urological surgery in the lithotomy position under spinal anesthesia at a tertiary care hospital. All participants had a BMI ≥18.5 kg/m² and were classified into two groups according to BMI (Group L: BMI <27.5 kg/m², Group H: BMI ≥27.5 kg/m²). Patients with contraindications to spinal anesthesia, extreme height (<150 cm or >190 cm), or who declined participation were excluded.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Adıyaman University Faculty of Medicine Anesthesiology and Reanimation | Merkez | Adıyaman Province | 02100 | Turkey (Türkiye) |
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Time in minutes from the intrathecal injection of hyperbaric bupivacaine until the maximum sensory block level is achieved. |
| From intrathecal injection to maximum sensory level |
| Time to two-segment regression of sensory block | Time in minutes from the maximum sensory block level until regression of sensory block by two thoracic dermatomes. | From maximum sensory block to two-dermatome regression |
| Time to reach Bromage score 3 | Time in minutes from the intrathecal injection until development of complete motor block in the lower extremities (Bromage score 3) | From intrathecal injection to complete motor block |
| Motor block recovery time(minutes) | Time in minutes from the intrathecal injection until the earliest detectable return of motor function in the lower extremities. | From intrathecal injection to earliest detectable return of motor activity |
| Hemodynamic parameters | Noninvasive systolic and diastolic arterial pressure and heart rate measured at baseline (before spinal anesthesia) and then at 5-minute intervals throughout the surgical procedure. | Baseline and every 5 minutes during surgery., |