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| Neuraxial anesthesia versus general anesthesia in patients undergoing three-dimensional laparoscopic radical prostatectomy: Preliminary results of a prospective comparative study |
Stefano Albaa,Deborah Fimognarib,Fabio Crocerossab,Luigi Ascalonea,Carmine Pullanoc,Fernando Chiaravallotid,Francesco Chiaradiaa,Umberto Carbonarae,Matteo Ferrof,Ottavio de Cobellif,g,Vincenzo Pagliaruloh,Giuseppe Lucarellii,Michele Battagliai,Rocco Damianob,Francesco Cantiellob,*( )
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a Department of Urology, Romolo Hospital, Rocca di Neto, Kr, Italy
b Department of Urology, Magna Graecia University of Catanzaro, Catanzaro, Italy
c Department of Anesthesiology, Villa Pia, Roma, Italy
d Department of Anesthesiology, Romolo Hospital, Rocca di Neto Kr, Italy
e Università degli Studi di Bari Aldo Moro, Department of Urology, Bari, Italy
f Division of Urology, European Institute of Oncology (IEO), IRCCS, Milan, Italy
g Department of Oncology and Hematology Oncology, Faculty of Medicine and Surgery, University of Milan, Milan, Italy
h Department of Urology, Vito Fazzi Hospital, Lecce, Italy
i Department of Emergency and Organ Transplantation-Urology, Andrology and Kidney Transplantation Unit, University of Bari, Bari, Italy |
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Abstract Objective 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).
Methods 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.
Results 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 vs. 6 days, p=0.05). t-3DLRP under NA had a statistically lower rate of minor complications (4.8% vs. 19.0%, p=0.03) and less postoperative pain (median numeric rating scale 3 vs. 4, p=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 (p=0.04).
Conclusion 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.
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Received: 14 January 2022
Available online:
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Corresponding Authors:
Francesco Cantiello
E-mail: cantiello@unicz.it
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| Variable | Total (n=84) | Neuraxial anesthesia (n=42) | General anesthesia (n=42) | p-Value | | Age, mean±SD, year | 68.2±2.1 | 68.1±2.2 | 69.1±1.8 | 0.10 | | Body mass index, mean±SD, kg/m2 | 27.7±1.7 | 27.3±1.4 | 28.2±2.0 | 0.08 | | Total PSA, mean±SD, ng/mL | 6.7±0.7 | 6.7±0.8 | 6.6±0.7 | 0.50 | | D'Amico risk group, n (%) | 0.80 | | Low | 16 (19.0) | 8 (19.0) | 8 (19.0) | | | Intermediate | 62 (73.8) | 32 (76.2) | 30 (71.4) | | | High | 6 (7.1) | 2 (4.8) | 4 (9.5) | | | Charlson comorbidity score, n (%) | 0.40 | | 0 | 22 (26.2) | 12 (28.6) | 10 (23.8) | | | >0 | 62 (73.8) | 30 (71.4) | 32 (76.2) | | | ASA score, n (%) | 0.40 | | 1 | 16 (19.0) | 6 (14.3) | 10 (23.8) | | | 2 | 52 (61.9) | 30 (71.4) | 22 (52.4) | | | 3 | 16 (19.0) | 6 (14.3) | 10 (23.8) | | | 4 | 0 | 0 | 0 | | | Clinical tumor stage, n (%) | 1.00 | | T1c | 72 (85.7) | 36 (85.7) | 36 (85.7) | | | T2 | 12 (14.3) | 6 (14.3) | 6 (14.3) | | | ISUP grade group on biopsy, n (%) | 0.80 | | 1 | 16 (19.0) | 8 (19.0) | 8 (19.0) | | | 2 | 34 (40.5) | 16 (38.1) | 18 (42.9) | | | 3 | 28 (33.3) | 16 (38.1) | 12 (28.6) | | | 4 | 6 (7.1) | 2 (4.8) | 4 (9.5) | | | ISUP grade group on RP, n (%) | 0.90 | | 1 | 12 (14.3) | 6 (14.3) | 6 (14.3) | | | 2 | 38 (45.2) | 20 (47.6) | 18 (42.9) | | | 3 | 26 (31.0) | 12 (28.6) | 14 (33.3) | | | 4 | 8 (9.5) | 4 (9.5) | 4 (9.5) | | | Pathological tumor stage, n (%) | 0.80 | | T2a | 26 (31.0) | 12 (28.6) | 14 (33.3) | | | T2b | 16 (19.0) | 8 (19.0) | 8 (19.0) | | | T2c | 24 (28.6) | 12 (28.6) | 12 (28.6) | | | T3a | 12 (14.3) | 8 (19.0) | 4 (9.5) | | | T3b | 6 (7.1) | 2 (4.8) | 4 (9.5) | | | Surgical margin status, n (%) | 0.70 | | Negative | 78 (92.9) | 40 (95.2) | 38 (90.5) | | | Positive | 6 (7.1) | 2 (4.8) | 4 (9.5) | | | Pathological lymph node status, n (%) | 0.90 | | Nx | 46 (54.8) | 22 (52.4) | 24 (57.1) | | | N0 | 34 (40.5) | 18 (42.9) | 16 (38.1) | | | N1 | 4 (4.8) | 2 (4.8) | 2 (4.8) | | | Nerve sparing, n (%) | 0.30 | | No nerve sparing | 34 (40.5) | 14 (33.3) | 20 (47.6) | | | Monolateral | 0 | 0 | 0 | | | Bilateral | 50 (59.5) | 28 (66.7) | 22 (52.4) | | | Preoperative Hb, mean±SD, g/dL | 14.9±0.8 | 14.9±0.8 | 14.8±0.7 | 0.70 | | Postoperative Hb, mean±SD, g/dL | 13.4±0.7 | 13.5±0.7 | 13.2±0.6 | 0.50 | | Estimated blood loss, median (IQR), mL | 180 (160-190) | 180 (150-200) | 180 (160-200) | 0.40 | | Operating room time, median (IQR), min | 150 (140-155) | 140 (130-150) | 150 (145-155) | 0.35 | | Trendelenburg position, median (range), degree | 20 (15-20) | 20 (15-20) | 20 (15-20) | 1.00 | | Intra-abdominal CO2 pressure, median (IQR), mmHg | 12 (9-14) | 13 (10-15) | 12 (8-15) | 0.60 | | Catheter removal time, median (IQR), day | 5 (4-6) | 5 (4-6) | 5 (4-6) | 1.00 | | Length of stay, median (IQR), day | 5 (4-6) | 5 (3-5) | 6 (6-7) | 0.05 | | NRS score (scales range from 0 to 10), median (IQR) | 3 (3-4) | 3 (2-3) | 4 (3-5) | 0.01 | | Postoperative complication, n (%) | | | Minor (Clavien-Dindo grades 1-2) | 10 (11.9) | 2 (4.8) | 8 (19.0) | 0.03 | | Major (Clavien-Dindo grades 3-5) | 0 | 0 | 0 | | | Would you repeat this kind of anesthesia? n (%) | | Yes | 74 (88.1) | 40 (95.2) | 34 (81.0) | 0.04 | | No | 10 (11.9) | 2 (4.8) | 8 (19.0) | | | Surgeons' assessment | | Quality of muscle relaxationa, mean±SD | 3.57±0.5 | 3.61±0.4 | 3.52±0.5 | 0.50 | | Continuity of muscle relaxation, n (%) | 73 (86.9) | 38 (90.5) | 35 (83.3) | 0.30 |
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Demographic, clinical, and pathological characteristics of the 84 patients included in the comparative analysis stratified by the type of anesthesia during laparoscopic radical prostatectomy.
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| Variable | Neuraxial anesthesia (n=42) | General anesthesia (n=42) | p-Value | | pCO2, mean±SD, mmHg | | Preoperative | 36.24±2.65 | 37.84±3.55 | 0.10 | | Postoperative | 39.69±1.96 | 40.69±1.33 | 0.06 | | pO2, mean±SD, mmHg | | Preoperative | 93.03±2.47 | 92.17±2.96 | 0.31 | | Postoperative | 92.04±1.60 | 92.86±1.09 | 0.06 | | HCO3?, mean±SD, mmol/L | | Preoperative | 23.12±0.82 | 22.54±1.13 | 0.07 | | Postoperative | 21.42±0.83 | 21.24±0.70 | 0.43 | | pH, mean±SD | | Preoperative | 7.37±0.05 | 7.39±0.04 | 0.25 | | Postoperative | 7.44±0.1 | 7.37±0.12 | 0.03 |
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Arterial blood gas parameters of the 84 patients included in the comparative analysis stratified by the type of anesthesia during laparoscopic radical prostatectomy.
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