General versus spinal anesthesia in patients undergoing radical retropubic prostatectomy: results of a prospective, randomized study.
OBJECTIVE
To evaluate the impact of general anesthesia (GA) versus spinal anesthesia (SpA) on intraoperative and postoperative outcome in patients undergoing radical retropubic prostatectomy.


METHODS
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.


RESULTS
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).


CONCLUSIONS
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.
Salonia
Andrea
A
Department ofUrology, University Vita-Salute San Raffaele, Scientific Institute H. San Raffaele, Milan, Italy.
Crescenti
Antonella
A
Suardi
Nazareno
N
Memmo
Antonella
A
Naspro
Richard
R
Bocciardi
Aldo M
AM
Colombo
Renzo
R
Da Pozzo
Luigi F
LF
Rigatti
Patrizio
P
Montorsi
Francesco
F
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D000762:Anesthesia Recovery Period; D000768:Anesthesia, General / Q000523:psychology; D000775:Anesthesia, Spinal / Q000523:psychology; D016063:Blood Loss, Surgical; D002045:Bupivacaine; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents; D010149:Postoperative Pain; D010342:Patient Acceptance of Health Care; D011229:Preanesthetic Medication; D015742:Propofol; D011446:Prospective Studies; D011468:Prostatectomy / Q000523:psychology; D011471:Prostatic Neoplasms / Q000601:surgery*; D013874:Thiopental; D014673:Vecuronium Bromide
D006993:Hypnotics and Sedatives; D003473:Neuromuscular Nondepolarizing Agents; D014673:Vecuronium Bromide; D013874:Thiopental; D005283:Fentanyl; D002045:Bupivacaine; D015742:Propofol