Impact of Thoracic Epidural Analgesia on Blood Loss in Radical Retropubic Prostatectomy

Abstract

Introduction: Radical retropubic prostatectomy (RRP) is associated with an increased risk of intraoperative blood loss and the necessity of transfusions. This prospective randomised clinical study evaluates the influence of thoracic epidural analgesia (TEA) on blood loss in RRP. Materials and Methods: 235 patients were randomised: TEA in group 1 (n = 116; general anaesthesia + TEA) comprised continuous administration of 0.25% bupivacaine, while group 2 (n = 119; general anaesthesia alone) received intravenous analgesia with fentanyl (intubation: 2 µg/kg; maintenance: 0.1- 0.3 mg). A restrictive infusion regimen (<1,000 ml until specimen removal) was administered in both groups. Blood loss, infusion rates and anaesthesiological parameters were recorded and analysed using regression models and analyses of variance. Results: Haemoglobin difference between the pre- and the first postoperative day (group 1: 3.35 ± 1.16 g/dl; group 2: 3.56 ± 1.42 g/dl; p = 0.19), overall blood loss (group 1: 665 ± 431.5 ml; group 2: 705 ± 881 ml; p = 0.73) and transfusion rates (0.4% intraoperatively; 2.55% postoperatively; p = 1.0) did not show group differences. In regression analysis blood loss was influenced by preoperative haemoglobin levels (p < 0.0001), patients' weight (p = 0.018) and duration of the operation (p = 0.017). Conclusions: This study did not demonstrate a direct impact of TEA on intraoperative blood loss and transfusion rates in RRP. Further randomised clinical trials are needed to evaluate an impact of the different anaesthetic procedures presented alone or in combination on blood loss.

Comparison of patient-controlled epidural analgesia with patient-controlled intravenous analgesia for laparoscopic radical prostatectomy

“…Hendolin et al [ 18 ] have also shown that the mean perioperative blood loss during operations under epidural analgesia is significantly less than that under general anesthesia (370 ± 34 ml vs. 590 ± 34 ml vs. 590 ± 35 ml). However, another study has reported that the hemoglobin difference between preand the first postoperative day did not show group differences in overall blood loss (general anesthesia + thoracic epidural analgesia: 665 ± 431.5 ml; only general anesthesia: 705 ± 881 ml; P = 0.73) or transfusion rate (0.4% intraoperatively; 2.55% postoperatively; P = 1.0) [ 19 ].…”

Measurement of Procedure-Specific Irrigation-Fluid Absorption in Transurethral Therapy of Lower Urinary Tract Syndrome, Using Ethanolic Saline and Breath Alcometry

“…This has not yet received a satisfactory pathophysiological explanation. A possible explanation for this substantial difference (p = 0.029) could be isoflurane-mediated vasodilation and sympathicolysis, which leads to the widening of blood vessels and thus reduces the opposing venous pressure [34]. …”

Processo de recuperação cirúrgica em pacientes submetidos à prostatectomia radical: estudo longitudinal de variáveis sociodemográficas, clínicas e psicológicas

“…Portanto, tais aspectos devem ser considerados na atenção dispensada ao paciente que, conforme destacam Sena; Nascimento e Maia, (2013), deve ocorrer de forma planejada, individualizada, baseada em evidências científicas, de acordo com o tipo de cirurgia que será realizada e a rotina implementada na instituição.…”

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