Alba Stefano, Fimognari Deborah, Crocerossa Fabio, Ascalone Luigi, Pullano Carmine, Chiaravalloti Fernando, Chiaradia Francesco, Carbonara Umberto, Ferro Matteo, de Cobelli Ottavio, Pagliarulo Vincenzo, Lucarelli Giuseppe, Battaglia Michele, Damiano Rocco, Cantiello Francesco
Department of Urology, Romolo Hospital, Rocca di Neto, Kr, Italy.
Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy.
Asian J Urol. 2023 Jul;10(3):329-336. doi: 10.1016/j.ajur.2022.04.006. Epub 2022 Oct 4.
Neuraxial anesthesia (NA) showed to reduce both morbidity and mortality in patients undergoing laparoscopic surgery. We aimed to investigate the use of NA in patients undergoing transperitoneal three-dimensional laparoscopic radical prostatectomy (t-3DLRP) and compare the intraoperative and postoperative outcomes with a control group of patients undergoing t-3DLRP under general anesthesia (GA).
A prospective, double-center, double-surgeon study cohort of 84 consecutive patients undergoing t-3DLRP between June 2019 and June 2021 was analyzed. A study group of 42 patients undergoing t-3DLRP under NA was compared with a control group of 42 patients undergoing t-3DLRP under GA.
The two group were similar in all demographic, clinical, and pathological variables. Postoperative blood gas parameters were within physiologic limits in both groups. Muscle relaxation was adequate for surgery during both NA and GA. Median length of stay was 1 day shorter for NA group than GA group (5 days . 6 days, =0.05). t-3DLRP under NA had a statistically lower rate of minor complications (4.8% 19.0%, =0.03) and less postoperative pain (median numeric rating scale 3 . 4, 0.01) compared to GA. No major complications were observed in both groups. Significantly more patients were willing to undergo a similar intervention under NA than GA (=0.04).
t-3DLRP under NA is a feasible and safe procedure, with less postoperative pain and fewer minor complications than the same procedure under GA. NA allows the maintenance of muscle relaxation and respiratory excursions without interfering with surgery.
神经轴索麻醉（NA）已被证明可降低腹腔镜手术患者的发病率和死亡率。我们旨在研究NA在接受经腹腔三维腹腔镜根治性前列腺切除术（t-3DLRP）患者中的应用，并将其术中及术后结果与接受全身麻醉（GA）的t-3DLRP对照组患者进行比较。
分析了2019年6月至2021年6月期间连续84例接受t-3DLRP的前瞻性、双中心、双术者研究队列。将42例接受NA下t-3DLRP的研究组患者与42例接受GA下t-3DLRP的对照组患者进行比较。
两组在所有人口统计学、临床和病理变量方面相似。两组术后血气参数均在生理范围内。NA和GA期间肌肉松弛均足以进行手术。NA组的中位住院时间比GA组短1天（5天对6天，P=0.05）。与GA相比，NA下的t-3DLRP轻微并发症发生率在统计学上更低（4.8%对19.0%，P=0.03），术后疼痛更少（数字评分量表中位数3对4，P=0.01）。两组均未观察到重大并发症。与GA相比，明显更多的患者愿意在NA下接受类似干预（P=0.04）。
NA下的t-3DLRP是一种可行且安全的手术，与GA下的相同手术相比，术后疼痛更少，轻微并发症更少。NA可在不干扰手术的情况下维持肌肉松弛和呼吸运动。
