Impact of thoracic epidural analgesia on blood loss in radical retropubic prostatectomy.
BACKGROUND
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.


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.
Department of Urology and Paediatric Urology, Magdeburg University Medical Centre, Magdeburg, Germany.
Daniel
D
Baumunk
Christof Maria
CM
Strang
Siegfried
S
Kropf
Michael
M
Schäfer
Mark
M
Schrader
Steffen
S
Weikert
Hannes
H
Cash
Jan
J
Breckwoldt
Kurt
K
Miller
Thomas
T
Hachenberg
Martin
M
Schostak
D061605:Administration, Intravenous; D000368:Aged; D015360:Analgesia, Epidural / Q000379:methods*; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D000779:Anesthetics, Local / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001835:Body Weight; D002045:Bupivacaine / Q000008:administration & dosage*; D005283:Fentanyl / Q000008:administration & dosage; D005858:Germany; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies; D011468:Prostatectomy / Q000009:adverse effects*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000601:surgery*; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D015415:Biomarkers; D006454:Hemoglobins; D005283:Fentanyl; D002045:Bupivacaine