General versus spinal anesthesia in patients undergoing radical retropubic prostatectomy: results of a prospective, randomized study

• Published in: Urology (Ridgewood, N.J.) Vol. 64; no. 1; pp. 95 - 100
• Main Authors: Salonia, Andrea, Crescenti, Antonella, Suardi, Nazareno, Memmo, Antonella, Naspro, Richard, Bocciardi, Aldo M, Colombo, Renzo, Da Pozzo, Luigi F, Rigatti, Patrizio, Montorsi, Francesco
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.07.2004; Elsevier Science
• Subjects: Adenocarcinoma - surgery; Aged; Anesthesia Recovery Period; Anesthesia, General - psychology; Anesthesia, Spinal - psychology; Biological and medical sciences; Blood Loss, Surgical; Bupivacaine; Fentanyl; Humans; Hypnotics and Sedatives - administration & dosage; Male; Medical sciences; Middle Aged; Nephrology. Urinary tract diseases; Neuromuscular Nondepolarizing Agents; Pain, Postoperative; Patient Acceptance of Health Care; Preanesthetic Medication; Propofol; Prospective Studies; Prostatectomy - psychology; Prostatic Neoplasms - surgery; Thiopental; Vecuronium Bromide; Human; Prospective; Nephrology; Treatment; Surgery; General anesthesia; Prostatectomy; Radical; Comparative study; Urology; Result
• ISSN: 0090-4295; 1527-9995
• DOI: 10.1016/j.urology.2004.03.010

To evaluate the impact of general anesthesia (GA) versus spinal anesthesia (SpA) on intraoperative and postoperative outcome in patients undergoing radical retropubic prostatectomy. Seventy-two consecutive patients with clinically localized prostate cancer were randomized into group 1 (GA: 34 patients) or group 2 (L2-L3 or L3-L4 SpA: 38 patients) and underwent radical retropubic prostatectomy. The intraoperative and postoperative anesthetic and surgical variables were evaluated. The mean ± SEM operative time was not significantly different between the two groups ( P = 0.43). The overall blood loss was less in group 2 ( P = 0.04). The mean ± SEM postoperative time in the postoperative holding area was significantly shorter after SpA than after GA ( P <0.0001). The perioperative pain outcome in the postoperative holding area was significantly better for group 2 than for group 1 ( P = 0.0017), but postoperative pain on day 1 was not significantly different between the two groups. The postoperative sedation score was significantly less in group 2 than in group 1 ( P <0.0001). On day 1, first flatus passed in a significantly larger number of patients in group 2 ( P <0.0001), and the overall gait was greater for group 2 patients ( P = 0.02). These results suggest that SpA allows good muscle relaxation and a successful surgical outcome in patients undergoing radical retropubic prostatectomy with pelvic lymphadenectomy for clinically localized prostate cancer. Moreover, SpA results in less intraoperative blood loss, less postoperative pain, and a faster postoperative recovery than GA.