General versus spinal anesthesia in patients undergoing radical retropubic prostatectomy: results of a prospective, randomized study

Abstract

Objectives 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.