title: Thoracic epidural analgesia for radical cystectomy improves bowel function even in traditional perioperative care: a retrospective study in eighty-five patients.
abstract: Radical cystectomy is associated with significant morbidity and mortality due to complex surgery and comorbidities associated with advanced age of patients. In contrast to the surgery, which is clearly the procedure of choice for patients with invasive bladder cancer, the opti- mal anesthesiologic method is still under debate. Therefore, we retrospectively analyzed 85 patients having undergone radical cystectomy at our institution, either under combined epidural-general anesthesia (CEGA) or opioid based general anesthesia (GA). The intraoperative blood loss was significantly lower in CEGA group (497.37 ± 354.13) than in GA group (742.31 ± 403.69; p = 0.006), due to induced hypotension. Consequently, blood transfusion requirements were lower in CEGA group (107.20 ± 263.92) than in GA group (388.18 ± 321.32; p = 0.001). The incidence of postoperative ileus was also lower in CEGA group (p = 0.024). There was no difference in analgesic efficacy, but a trend towards lower incidence of venous thrombosis and infection was noticed. The results of our study suggest that epidural anesthesia might have specific advantages in patients undergoing radical cystectomy.
authors.forename: Branka
authors.initials: B
authors.lastname: Mazul-Sunko
authors.forename: Ivan
authors.initials: I
authors.lastname: Gilja
authors.forename: Milana
authors.initials: M
authors.lastname: Jelisavac
authors.forename: Iva
authors.initials: I
authors.lastname: Kožul
authors.forename: Damir
authors.initials: D
authors.lastname: Troha
authors.forename: Nedžad
authors.initials: N
authors.lastname: Osmančević
authors.forename: Ahmad
authors.initials: A
authors.lastname: El-Saleh
authors.forename: Ana
authors.initials: A
authors.lastname: Markić
authors.forename: Marko
authors.initials: M
authors.lastname: Kovačević
authors.forename: Petar
authors.initials: P
authors.lastname: Bokarica
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015360:Analgesia, Epidural / Q000379:methods; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D016063:Blood Loss, Surgical / Q000517:prevention & control; D015653:Cystectomy / Q000009:adverse effects; D005260:Female; D005772:Gastrointestinal Transit / Q000187:drug effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000517:prevention & control; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000473:pathology / Q000601:surgery*
chemical_list: D000701:Analgesics, Opioid