Clinical results of combined epidural and general anesthesia procedure in radical prostatectomy management.

OBJECTIVES

Improvement of radical prostatectomy surgical technique remains an objective for urological practice. The aim of this study was to evaluate the potential benefit of intra and postoperative epidural versus general anesthesia alone.

MATERIAL AND METHODS

The authors retrospectively analyzed 62 consecutive cases of patients who underwent radical retropubic prostatectomy over a 2-year period. The mean age was 65.5 years (51-75). Two groups were selected: group I = 19 patients, who received epidural anesthesia in association with general anesthesia and group II = 43 patients with general anesthesia alone. Both groups were similar for ASA score, Body Mass Index, prostate volume, tumor stage and Gleason score. Evaluation criteria were operative time, blood loss, postoperative pain (analgesics required) and length of hospital stay. Mono and multifactorial statistical analysis were performed.

RESULTS

Operative time in group I was 189 mn versus 218 mn for group II (p = 0.01). Significant difference was found independent of surgical experience. Moreover, significant blood loss (p = 0.002) was observed: 971 ml in group I versus 1840 ml in group II. Also, less blood was transfused during surgery in group I: 0.84 blood units transfused versus 2.60 blood units in group II (p = 0.007). In both groups, hematocrit level remained stable during surgery. As regards postoperative pain, an improvement in required analgesic level was noted in group I during the initial 48 hours (p = 0.001 for day 1; p = 0.032 for day 2). Finally, mean hospital stay was only 9.3 days in group I and 12.4 days in group II (p = 0.005).

CONCLUSION

Our study suggests that improved results can be obtained when epidural anesthesia is associated with general anesthesia in radical retropubic prostatectomy intra and postoperative management, with a significant reduction in morbidity.