Effect of unilateral intrathecal prilocaine–fentanyl versus bupivacaine–fentanyl on postoperative spontaneous voiding in ambulatory male patients undergoing inguinal hernioplasty: a randomized double-blinded comparative study

Theodor Bilharz Research Institute

Bibliographic Information

Authors: Mohamed M.A.E.; Helmy M.A.; Hashem O.M.E.A.; Shash A.M.; Osman E.S.; Mohamed A.E.; Taha M.M.R.

Journal: Scientific Reports

Publisher: Nature Research

Publication Date: 5 July 2026

Volume / Issue: Volume 16 / Issue 1

Article No.: 20569

ISSN: 20452322

DOI: 10.1038/s41598-026-59157-8

Scopus: View on Scopus

PubMed: 42402656

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

Mohamed M.A.E., Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt; Helmy M.A., Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt; Hashem O.M.E.A., Department of Anesthesia and Critical Care Medicine, Theodor Bilharz Research Institute, Cairo, Egypt; Shash A.M., Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt; Osman E.S., Department of Anesthesia and Critical Care Medicine, Theodor Bilharz Research Institute, Cairo, Egypt; Mohamed A.E., Department of Anesthesia and Critical Care Medicine, Theodor Bilharz Research Institute, Cairo, Egypt; Taha M.M.R., Department of Anesthesia and Critical Care Medicine, Cairo University, Cairo, Egypt

Abstract

Ambulatory inguinal hernia repair requires anesthetic techniques that provide reliable intraoperative analgesia while facilitating rapid recovery and timely discharge. Postoperative spontaneous voiding is a critical determinant of discharge readiness. This study compared unilateral intrathecal prilocaine–fentanyl with bupivacaine–fentanyl in male patients undergoing elective inguinal hernioplasty. In this randomized comparative trial, 70 male patients (ASA I–II, aged 18–60 years) scheduled for elective unilateral inguinal hernia repair were allocated to receive either intrathecal prilocaine 40 mg plus fentanyl 25 µg (Pr‑F group, n = 35) or bupivacaine 7.5 mg plus fentanyl 25 µg (Bu‑F group, n = 35). Blocks were performed unilaterally with patients maintained in the lateral decubitus position for 15 min. The primary outcome was time to first spontaneous voiding. Secondary outcomes included block characteristics, recovery parameters, pain scores, rescue analgesia, discharge readiness (Modified Post-Anesthesia Discharge Scoring System ≥ 9), and adverse events. Baseline demographics and intraoperative hemodynamics were comparable between groups. The Pr‑F group demonstrated significantly shorter time to first spontaneous voiding (213 ± 27 vs. 307 ± 22 min, p < 0.001). Motor and sensory regression times were also shorter with prilocaine (98 ± 11 vs. 187 ± 19 min; 120 ± 11 vs. 209 ± 23 min, respectively; p < 0.001). Time to achieve Modified Post-Anesthesia Discharge Scoring System ≥ 9 was reduced in the Pr‑F group (97 ± 11 vs. 187 ± 19 min, p < 0.001). Pain scores were higher with prilocaine, and rescue analgesia was required more frequently (34% vs. 11%, p = 0.023). Kaplan–Meier analysis confirmed earlier voiding in the Pr‑F group (log‑rank χ²=82.85, p < 0.0001). Adverse events, including pruritus, shivering, urinary retention, and transient neurological symptoms, were infrequent and comparable between groups. Unilateral intrathecal prilocaine–fentanyl provided faster recovery of sensory and motor function, earlier spontaneous voiding, and shorter discharge times compared with bupivacaine–fentanyl in male patients undergoing ambulatory inguinal hernia repair. Both regimens were safe, but prilocaine–fentanyl offers distinct advantages for fast‑track hernia surgery. Larger multicenter studies are warranted to confirm these findings across broader patient populations. Trial registration: The study was registered retrospectively at ClinicalTrials.gov (Identifier: NCT07262398) on 14/11/2025. © The Author(s) 2026.

Keywords

Ambulatory surgery; Bupivacaine; Discharge readiness; Fentanyl; Inguinal hernia; Prilocaine; Spinal anesthesia; Urinary retention; Adolescent; Adult; Ambulatory Surgical Procedures; Anesthetics, Local; Double-Blind Method; Hernia, Inguinal; Herniorrhaphy; Humans; Injections, Spinal; Male; Middle Aged; Postoperative Pain; Urination; Young Adult; local anesthetic agent; adverse event; comparative study; controlled study; double blind procedure; drug effect; drug therapy; human; intraspinal drug administration; micturition; procedures; randomized controlled trial; surgery

Citation Information

Scopus Citations: 0

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