Anesthesia for Open Radical Retropubic Prostatectomy: A Comparison between Combined Spinal Epidural Anesthesia and Combined General Epidural Anesthesia

Abstract

Background. Several anesthesiologic regimens can be used for open radical retropubic prostatectomy. The aim of this retrospective analysis was to compare the combined general epidural anesthesia and the combined spinal epidural anesthesia with regard to availability, efficacy, side effects, and perioperative time consumption in a high-volume center. Methods. A retrospective analysis was performed by querying the electronic medical records of 1207 consecutive patients from the database of our online documentation software. All patients underwent open radical retropubic prostatectomy from 01/2008 to 08/2011 and met the study criteria. Linear and multivariate regression analyses were performed to identify differences in parameters such as time consumption in the operating unit, hemodynamic parameters, volume replacement, and catecholamine therapy. Results. 698 (57.8%) patients have been undergoing open radical retropubic prostatectomy under combined spinal epidural anesthesia and 509 (42.2%) patients by combined general epidural anesthesia. Operating unit (p <0.0001) and post-anesthesia care unit stay (p <0.0001) as well as total hospital stay (p <0.0001) were significantly shorter in the combined spinal epidural anesthesia group. In addition, this group had reduced intraoperative volume need (p <0.0001) as well as lower need of catecholamines (p <0.0001). Conclusions. This retrospective study suggests that the combined spinal epidural anesthesia seems to be a suitable and efficient anesthesia technique for patients undergoing open radical retropubic prostatectomy. This specific approach reduces time in the operation unit and length of hospital stay.

The impact of spinal anaesthesia on perioperative opioid consumption, postoperative pain and oncological outcome in radical retropubic prostatectomy—a retrospective before-and-after effectiveness study

“…It is well known that the severity of pain both at rest and with activity correlates with a decrease in the patients’ quality of recovery in the immediate postoperative period (Bowyer et al 2014 ). Regional anaesthesia techniques that have been used for improving analgesia and sparing opioids after RRP include epidural and spinal anaesthesia for more than half a century, and more recently, intrathecal opioid administration, transversus abdominis-plane block and local wound infiltration (Gardner 1958 ; Shir et al 1994 ; Kofler et al 2019 ; Fant et al 2011 ; Andrieu et al 2009 ; Yu et al 2014 ; Tauzin-Fin et al 2009 ). Some ERAS protocols suggest to use thoracic epidural anaesthesia for superior pain relief in open abdominal surgery (Cerantola et al 2013 ).…”

“…Spinal anaesthesia has been preferred in several institutions because it provides good muscle relaxation, minimal bleeding during the procedure, a fast postoperative recovery and is reported to decrease postoperative pain and supplemental intravenous opioid demand compared to general anaesthesia (Kofler et al 2019 ; Salonia et al 2004 ). Brown et al compared general anaesthesia with a general anaesthesia preceded by spinal anaesthesia with intrathecal administration of bupivacaine, clonidine and morphine (Brown et al 2004 ).…”

“…The potential impact of neuraxial regional anaesthesia on major abdominal oncologic surgery is a reduction of intraoperative bleeding, reduced neuroendocrine stress response to the surgical trauma, less opioid requirements, less immunosuppression, reduced postoperative pain and cancer recurrence. (Shir et al 1994;Brown et al 2004;Salonia et al 2006;Dale 1953;Kofler et al 2019). This has been proposed against the background that major oncological surgery induces a neuroendocrine, metabolic and cytokine response, resulting in an immunosuppression in the perioperative period.…”

The effects of method of anaesthesia on the safety and effectiveness of Radical Retropubic Prostatectomy

“…Patients receiving CESA remained in the operating theatre for a shorter period of time (average -3.5 minutes), compared to those receiving GA, and furthermore their hospitalisation was significantly shorter (-0.6 days). A shorter operating theatre and hospital stay is beneficial for both patients and Health Services alike, because it reduces patients' exposure to specific pathogens, reduces anxiety and, at the same time, reduces costs (15,17). By streamlining the CESA technique for RRP, the duration of surgery will further decrease, leaving time for more operations, thereby increasing hospital incomes (18).…”

Changing urological practice during COVID-19

“…The majority of oncological procedures have been performed under RA with equivalent outcomes. [ 35 36 ] In pelvic surgeries, Combined Epidural Spinal Anasthesia (CESA) offers the advantages of reduced volume need, decreased perioperative blood loss, and maintaining postoperative analgesia. [ 37 ] For pelvic surgeries, Trendelenburg position should be minimized to avoid pulmonary congestion, respiratory compromise, and aerosol production.…”