General Anesthesia versus Epidural and General Anesthesia in Radical Cystectomy

Abstract

Introduction: The aim of this study is to compare two different anesthetic techniques in radical cystectomy with regard to blood loss, transfusional requirements, intraoperative complications and the quality of analgesia. Materials and Methods: 50 patients scheduled for radical cystectomy were randomized to two groups: group GA – general anesthesia, n = 25 and group CEGA – combined epidural and general anesthesia. The patients were monitored and hemodynamic changes, intraoperative bleeding, transfusional requirements, quality of analgesia and postoperative complications were evaluated. Results: There were no significant differences between the demographic characteristics of the two groups. Intraoperative bleeding which was 874.8 ± 190.7 ml in the CEGA group and 1,248.3 ± 343.4 ml in the GA group was statistically different (p < 0.05). Significantly more intraoperative blood transfusions in terms of units were required in the GA group. Analgesia was better in the CEGA group, with VAS values at 0, 1, 2, 4, 6, 12 and 24 h significantly (p < 0.05) lower than those observed in the GA group. No significant differences in intraoperative hemodynamic parameters or postoperative complications were noted between the two groups. Conclusions: Statistically significant differences in intraoperative bleeding were observed between the two groups: CEGA provides lower intraoperative bleeding and a better postoperative analgesia. Major operations such as radical cystectomy, which also is associated with considerable blood loss, a combination of general and epidural anesthesia may allow for less blood loss, with a better postoperative analgesia and without any increase in complications.

Effect of Intraoperative Red Blood Cell Transfusion on Postoperative Complications After Open Radical Cystectomy: Old Versus Fresh Stored Blood

“…24 Therefore, it is reasonable to decrease the number of intraoperative blood transfusions. Various strategies, such as a combining epidural with general anesthesia, 25 new technical apparatuses for hemostasis, 26,27 autotransfusion using intraoperative cell salvage, 28 and meticulous surgical performance may help reduce blood loss, the need for …”

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.…”

“…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.…”