Epidural and general anesthesia versus general anesthesia in radical prostatectomy

Abstract

Induced hypotension with epidural anesthesia influences the intraoperative blood loss in prostate cancer patients undergoing radical prostatectomy. The aim of this study was to evaluate intraoperative blood loss and need of blood transfusions in patients who underwent radical prostatectomy under epidural/general anesthesia and general anesthesia. Two groups were selected: epidural/general anesthesia group (study group, 27 patients) received epidural anesthesia in association with general anesthesia, and general anesthesia group (control group, 27 patients) received general anesthesia alone. Epidural/general anesthesia was performed using 0.5% solution of bupivacaine and maintained by volatile anesthetic sevoflurane. General anesthesia was performed with endotracheal ventilation using sevoflurane and intravenous fentanyl. The present study showed that the mean blood loss in epidural/general anesthesia group was significantly lower in comparison with that of general anesthesia group (740±210 mL versus 1150±290 mL, P<0.001). In addition, less allogeneic blood was transfused in epidural/general anesthesia group: 0.19 blood units transfused versus 0.52 blood units in general anesthesia group (P=0.007). Our study proved that induced hypotension with epidural/general anesthesia reduced intraoperative blood loss and need of allogeneic blood transfusions in cancer patient undergoing open radical prostatectomy.

Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review

“…[11][12][13][14][15][16][17][18][19][20][21] Pooling the results to produce a meta-analysis was not possible. The decision not to perform a meta-analysis took into account the fact that the interventions and outcomes assessed were different among the RCTs included.…”

“…Tikuisis et al 12 reported the mean without standard deviation; O'Connor et al 13 reported the number of patients who received blood transfusion; Ozyuvaci et al 14 reported this outcome for radical cystectomy; Salonia et al 15 reported autologous and heterologous blood transfusions; and the data from Shir et al, 18 Hendolin et al 20 and McGowan et al 21 were not taken into consideration because the anesthetic technique used was not the same as used today. Hendolin et al 20 used sodium thiopental, succinylcholine and alcuronium.The basilic vein was used for venous pressure measurement, and the left radial artery was cannulated for blood gas measurement.…”

“…RCTs had more than five "yes" answers in the Delphi list analysis; 13,16 the allocation concealment was described correctly in four RCTs; 11,13,14,16 the sequence generation method was not described in seven RCTs; 11,12,15,17,[19][20][21] and blinding was not described in eight RCTs. [11][12][13][14][15]17,19,21 One study was described as single-blind.…”

“…[11][12][13][14][15]17,19,21 One study was described as single-blind. 13 The length of follow-up was three months in one RCT whereas it was the length of hospital stay in the other RCTs.…”

“…O'Connor et al 13 Ozyuvaci et al 14 Salonia et al 15 Shir et al 19 Tikuisis et al 12 Random sequence generation Allocation concealment Blinding of participants and personnel Blinding of outcome assessment Incomplete outcome data Selective reporting Other bias + Low risk of bias -High risk of bias ± Unclear risk of bias Blood transfusion requirements: more units of blood transfusion were used in GA group.…”