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Tomar A, Yadav JBS, Singh D, Singh RB, Verma RR, Pandey S. Comparative Study of Spinal, Epidural, and Sequential Combined Spinal Epidural Anesthesia in Geriatric Patients for Transurethral Resection of the Prostate. Cureus 2024; 16:e58099. [PMID: 38741861 PMCID: PMC11088975 DOI: 10.7759/cureus.58099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Sequential combined spinal epidural anesthesia (CSEA) is probably the greatest advancement in the central neuraxial block in this decade for geriatric patients due to the potential advantages of both spinal and epidural anesthesia. This study was designed to compare the clinical effects of sequential CSEA versus spinal and epidural anesthesia in geriatric patients undergoing transurethral resection of the prostate (TURP). METHODS Ninety patients aged 65 to 80 years were randomly allocated into three groups of 30 each. Group A (n=30) patients were administered spinal anesthesia with 2.5 ml of 0.5% hyperbaric bupivacaine, group B (n=30) received epidural anesthesia with 15 ml of 0.5% isobaric bupivacaine, and group C (n=30) received sequential CSEA with 1 ml of 0.5% hyperbaric bupivacaine and 6 ml of 0.5% isobaric bupivacaine given through epidural route to extend the block up to T10. Patients were observed for hemodynamic parameters, sensory and motor block, total dose required to establish the desired level, and patient satisfaction score. RESULTS None of the patients were excluded in the study. Group A patients reported rapid onset of sensory block (3.08±11.57 minutes) compared to group B (11.57±1.48 minutes), and group C (5.47±1.25 minutes). The onset of motor block was expeditious in group A (8.08±1.0 minutes) compared to group B (20.33±1.86 minutes) and group C (15.53±1.31 minutes). Patients in group B had maximum hemodynamic stability but with delayed onset and were technically more complex than group A. Patients in group C were hemodynamically more stable than group A. They had a faster onset of action with decreased doses of local anesthetic drug required compared to group B. CONCLUSION Sequential CSEA is a safe, effective, and reliable technique that combines the advantages of both spinal and epidural while minimizing their disadvantages. It has the advantage of stable hemodynamic parameters along with the provision of prolongation analgesia for geriatric patients undergoing TURP surgery.
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Affiliation(s)
- Arvind Tomar
- Anesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, IND
| | | | - Dheer Singh
- Anesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, IND
| | | | | | - Sarika Pandey
- Anesthesiology, Uttar Pradesh University of Medical Sciences, Saifai, IND
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Patil AJ, Patel AR, Pande BS. Retrograde intrarenal surgery with central neuraxial blockade versus general anesthesia: A systematic review and meta-analysis. Saudi J Anaesth 2024; 18:231-239. [PMID: 38654871 PMCID: PMC11033904 DOI: 10.4103/sja.sja_16_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 01/20/2024] [Indexed: 04/26/2024] Open
Abstract
Objective The aim of the article is to assess the impact of retrograde intrarenal surgery under central neuraxial blockade in comparison to general anesthesia (GA). Material and Methodology This systematic review was conducted following the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses. We conducted a comprehensive search across major electronic databases, including various types of studies such as descriptive studies and full-text literature, all of which were incorporated into the current review from 2018 to 2023. We involved those studies, which included the comparative study of spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal epidural anesthesia with GA. Result In our meta-analysis of 12 studies, it was found that anesthesia technique significantly affected operation time, with neuraxial anesthesia (NA) showing a mean difference of -2.28 (95% confidence interval (CI): -3.5 to -1.04, P = 0.003) compared to GA. However, there were no significant differences in rates of stone clearance, 24-h pain scores and length of hospital stay among patients administered with NA or GA for retrograde intrarenal surgery (RIRS). Conclusion On the basis of the outcomes of study, NA can serve as a viable alternative to GA for RIRS. Our analysis reveals no significant differences in rates of stone clearance, operation duration, 24-h pain scores, complication rates, and length of hospital stay between NA in addition to GA in the context of RIRS. This suggests that given the potential economic advantages, NA might be a preferable choice over GA, contingent on patient preferences, baseline characteristics, and stone burden.
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Kim YJ, Yoon HK, Kang YJ, Oh SJ, Hur M, Park HP, Lee HC. Autonomic responses during bladder hydrodistention under general versus spinal anaesthesia in patients with interstitial cystitis/bladder pain syndrome: a randomized clinical trial. Sci Rep 2023; 13:9248. [PMID: 37286619 DOI: 10.1038/s41598-023-36537-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 06/06/2023] [Indexed: 06/09/2023] Open
Abstract
Blocking the abrupt increase in systolic blood pressure associated with autonomic response during bladder hydrodistention in patients with interstitial cystitis/bladder pain syndrome (IC/BPS) is essential for patient safety. We conducted this study to compare autonomic responses during bladder hydrodistention in patients with IC/BPS under general and spinal anaesthesia. Thirty-six patients were randomly allocated to a general anaesthesia (GA, n = 18) or a spinal anaesthesia (SA, n = 18) group. Blood pressure and heart rate were measured continuously and ΔSBP, defined as maximum increases in SBP during bladder hydrodistention from baseline, was compared between groups. Heart rate variability was analysed using electrocardiograms. The post-anaesthesia care unit assessed postoperative pain using a numeric (0-10) rating scale. Our analyses yield a significantly greater ΔSBP (73.0 [26.0-86.1] vs. 2.0 [- 4.0 to 6.0] mmHg), a significantly lower root-mean-square of successive differences in heart rate variability after bladder hydrodistention (10.8 [7.7-19.8] vs. 20.6 [15.1-44.7] ms), and significantly higher postoperative pain scores (3.5 [0.0-5.5] vs. 0.0 [0.0-0.0]) in the GA compared to the SA group. These findings suggest that SA has advantages over GA for bladder hydrodistention in preventing an abrupt increase in SBP and postoperative pain in IC/BPS patients.
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Affiliation(s)
- Yoon Jung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyun-Kyu Yoon
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Yu Jin Kang
- Department of Urology, Pohang St Mary's Hospital, Pohang-si, Gyeongsangbuk-do, South Korea
| | - Seung-June Oh
- Department of Urology, Seoul National University College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Min Hur
- Department of Anesthesiology and Pain Medicine, Ajou University College of Medicine, Suwon, South Korea
| | - Hee-Pyoung Park
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea
| | - Hyung-Chul Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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Duan M, Chen Y, Sun L. Outcomes of Retrograde Intrarenal Surgery Performed Under Neuraxial vs. General Anesthesia: An Updated Systematic Review and Meta-Analysis. Front Surg 2022; 9:853875. [PMID: 35360428 PMCID: PMC8960175 DOI: 10.3389/fsurg.2022.853875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Background The current review aimed to assess if the outcomes of retrograde intrarenal surgery (RIRS) differ with neuraxial anesthesia (NA) or general anesthesia (GA). Methods The databases of PubMed, Embase, CENTRAL, ScienceDirect, and Google Scholar were searched up to 3rd December 2021 for randomized controlled trials (RCTs) and observational studies comparing outcomes of RIRS with NA or GA. Results Thirteen studies involving 2912 patients were included. Eight were RCTs while remaining were observational studies. Meta-analysis revealed that stone free status after RIRS did not differ with NA or GA (OR: 0.99 95% CI: 0.77, 1.26 I2 = 10% p = 0.91). Similarly, there was no difference in operation time (MD: -0.35 95% CI: -4.04, 3.34 I2 = 89% p = 0.85), 24 h pain scores (MD: -0.36 95% CI: -0.96, 0.23 I2 = 95% p = 0.23), length of hospital stay (MD: 0.01 95% CI: -0.06, 0.08 I2 = 35% p = 0.78), Clavien-Dindo grade I (OR: 0.74 95% CI: 0.52, 1.06 I2 = 13% p = 0.10), grade II (OR: 0.70 95% CI: 0.45, 1.07 I2 = 0% p = 0.10) and grade III/IV complication rates (OR: 0.78 95% CI: 0.45, 1.35 I2 = 0% p = 0.37) between NA and GA. Except for grade I complications, the results did not change on subgroup analysis based on study type and NA type. Conclusion Our results suggest that NA can be an alternative to GA for RIRS. There seem to be no difference in the stone-free rates, operation time, 24-h pain scores, complication rates, and length of hospital stay between NA and GA for RIRS. Considering the economic benefits, the use of NA may be preferred over GA while taking into account patient willingness, baseline patient characteristics, and stone burden. Systematic Review Registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42021295407.
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Affiliation(s)
- Mingda Duan
- Department of Anesthesiology, Hainan Hospital of Chinese PLA General Hospital, Sanya, China
| | - Yu Chen
- Department of Anesthesiology, Sixth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Li Sun
- Department of Anesthesiology, First Medical Center of Chinese PLA General Hospital, Beijing, China
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Çilesiz NC, Özkan A, Kalkanlı A, Gezmiş CT, Yazıcı G, Onuk Ö, Nuhoğlu B. Spinal Anesthesia Provides Longer Administration Time for Postoperative Intravesical Chemotherapy after TUR-B Operation. Urol Int 2021; 106:768-774. [PMID: 34333492 DOI: 10.1159/000517790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 06/02/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE The aim of this study was to investigate the tolerability of postoperative early intravesical chemotherapy session after transurethral resection of the bladder tumor (TUR-B) according to the different anesthesia types. METHODS The study was conducted between February 2017 and June 2020. Patients who were given intravesical mitomycin (MMC) 40 mg after TUR-B were included. Patients' risk categories (low, medium, and high) were determined according to the European Association of Urology (EAU) risk stratification system based on the tumor number, size (<3 and ≥3 cm), T stage (Ta and T1), and grade (low and high). Patients were divided into 2 groups according to the applied anesthesia technique as group S (spinal) and group G (general). The patients' visual analog scale (VAS) scores were recorded every 30 min for 2 h after urethral clamping. The patients' pain scores were recorded using the VAS questionnaire form at 30th (VAS1), 60th (VAS2), 90th (VAS3), and 120th (VAS4) min after the urethral clamping. Requirement of analgesic, urethral clamp removal time, total instillation time, and discharged urine volume were recorded. Complications and complication grade (1-5) were recorded according to the Clavien-Dindo system. RESULTS A total of 232 consecutive patients who received intravesical MMC were included. Sociodemographic characteristics of group S (n = 113) and group G (n = 119) were similar (p < 0.05). There were no significant differences in tumor size, number of tumors, concomitant CIS, and T stage in both groups (p > 0.05). High-grade tumors were higher in group S (23.9 vs. 11%; p = 0.008). Requirement of analgesic (53.9 vs. 91.5%; p = 0.00) and termination of therapy <60' (2 vs. 26%; p = 0.00) and <120' (32.7 vs. 76.4%; p = 0.00) were significantly lower in group S. The mean instillation time (108.05 ± 19.40 vs. 85.67 ± 24.66 min; p = 0.00) was found significantly higher for group S. In group G, mean VAS1-4 scores were significantly higher than in group S (p < 0.05). Linear correlation analyses showed that the VAS score is correlated with the instillation time (p < 0.05). The rates of minor (I-III) (7 vs. 8%; p = 0.706) and major (IV-V) (0.9 vs. 1.6%; p = 0.590) complications were similar in both groups. CONCLUSION The patients' tolerability of intravesical MMC treatment can be improved by spinal anesthesia. It provides longer instillation time and less pain during intravesical chemotherapy.
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Affiliation(s)
- Nusret Can Çilesiz
- Department of Urology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Arif Özkan
- Department of Urology, Koç University, Istanbul, Turkey
| | - Arif Kalkanlı
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Cem Tuğrul Gezmiş
- Department of Urology, Taksim Education and Research Hospital, Istanbul, Turkey
| | - Gökhan Yazıcı
- Department of Urology, Gaziosmanpaşa Education and Research Hospital, Istanbul, Turkey
| | - Özkan Onuk
- Department of Urology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
| | - Barış Nuhoğlu
- Department of Urology, Istanbul Yeni Yüzyıl University, Istanbul, Turkey
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Spinal versus general anesthesia during retrograde intra-renal surgery: A propensity score matching analysis. Curr Urol 2021; 15:106-110. [PMID: 34168529 PMCID: PMC8221011 DOI: 10.1097/cu9.0000000000000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 11/08/2019] [Indexed: 11/08/2022] Open
Abstract
Background: The indications for retrograde intra-renal surgery (RIRS) have greatly increased, however, there is still no consensus on the use of spinal anesthesia (SA) during this procedure. The aim of this study was to evaluate the comparability of surgical conditions and outcomes with RIRS performed under SA versus general anesthesia (GA) for renal stones. Materials and methods: This was a prospective, observational study in patients scheduled for RIRS in a single teaching hospital in Italy. Inclusion criteria were age >18 years and the presence of single or multiple renal stones. We recorded information concerning the site of lithiasis, the number of calculi, total stone burden, and the presence of concomitant ureteral stones or hydronephrosis. A propensity score-matched analysis was performed to evaluate the results in terms of surgical outcome, intraoperative and postoperative complications, and analgesia demand balanced for confounding factors. Patients were followed-up until day 90 from discharge. Results: We included 120 patients, the propensity score-matched cohort included 40 patients in the SA and 40 in the GA groups. The stone-free rate was 67.5% in the GA group and 70.0% in the SA group (p = 0.81). The use of auxiliary procedures within 90 days did not differ between groups (25.0% vs. 22.5%, p = 0.79). No cases of conversion from SA to GA were recorded. We did not find any differences in intraoperative bleedings, perforations, and abortions. Complication rates were similar in the 2 groups (10.0% in GA vs. 5.0% in SA, p = 0.64). Conclusions: In our cohort, RIRS performed under SA and GA was equivalent in terms of surgical results and complications.
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Ghaffari S, Dehghanpisheh L, Tavakkoli F, Mahmoudi H. The Effect of Spinal versus General Anesthesia on Quality of Life in Women Undergoing Cesarean Delivery on Maternal Request. Cureus 2018; 10:e3715. [PMID: 30788204 PMCID: PMC6373886 DOI: 10.7759/cureus.3715] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Introduction The proportion of women electing for cesarean delivery has increased in both developed and developing countries. Cesarean delivery on maternal request (CDMR) refers to a primary cesarean delivery performed because the mother requests this method of delivery in the absence of standard medical/obstetrical indications. Several studies compared anesthesia modalities in cesarean section regarding clinical outcomes such as maternal mortality, post-operative pain and bleeding, but only a few compared health-related quality of life (HRQoL) of women undergoing general anesthesia versus spinal anesthesia. The aim of this study was to determine whether pregnant women who undergo general anesthesia (GA) for cesarean delivery compared with spinal anesthesia (SA) differ regarding their perceived HRQoL. Methodology We enrolled 160 pregnant women with American Society of Anesthesiologists (ASA) class II, scheduled for CDMR with GA or SA. Anesthesia modality was based on patient’s preference. Participants assessed their state of health with the EuroQoL-5 Dimensions-3 Levels (EQ-5D-3L) self-administered questionnaire at four time points: six hours before cesarean delivery, 24 hours after cesarean delivery, one week and one month after cesarean delivery. Patients also rated their health on the EQ visual analog scale (EQ-VAS) from 100 mm “best imaginable health state” to 0 mm “worst imaginable health state”. Results More women who underwent spinal anesthesia reported “no problem” with regards to “mobility’ (64% vs. 30%, p = 0.00), “usual activities” (90% vs. 38%, p = 0.00), and “pain/discomfort” (20% vs. 5%, p = 0.007). Repeated measurement analysis showed that the two groups started off with the same EQ-VAS score, however, both decreased over time with different slope resulting in different scores at 24 hours after CS. Then the scores increased in both groups over time and ended up being rather close at one month after CS. Discussion Unless there is a contraindication, neuraxial anesthesia is the anesthetic technique of choice for cesarean delivery in all parturient in general. This concept is based on more mortality and morbidity that have been seen with general anesthesia in this particular population. Our study demonstrated significant advantages of spinal anesthesia compared to general anesthesia in cesarean section regarding postoperatively perceived HRQoL. We showed that more pregnant women who chose spinal anesthesia as their anesthesia modality reported “no problem” with respect to “mobility” and “Self-care” 24 hours after cesarean section. On the top of that, more women in this group had “no problem” in their “usual activities” at one week and one month after cesarean delivery time points. Moreover, EQ-5D general health score was higher 24 hours after cesarean delivery with regional anesthesia comparing to general anesthesia. Conclusion We determined that compared to general anesthesia, spinal anesthesia is the technique of choice for cesarean section because not only it avoids a general anesthetic and the risk of failed intubation, but also because it provides effective pain control, mobility and fast return back to daily activities for new mothers and increase their quality of life.
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Affiliation(s)
| | | | | | - Hilda Mahmoudi
- Epidemiology and Public Health, Nova Southeastern University School of Osteopathic Medicine, Miami, USA
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Hemmerling TM. Pain management in abdominal surgery. Langenbecks Arch Surg 2018; 403:791-803. [PMID: 30284029 DOI: 10.1007/s00423-018-1705-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/26/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Abdominal surgery has undergone major changes during the last two decades with a general shift from open, invasive surgery to closed minimally invasive surgery. Accordingly, pain management strategies have also changed, especially with the introduction of ultrasound-guided abdominal wall blocks. Despite laparoscopic abdominal surgery classified as minimal, pain can be quite significant and needs to be addressed appropriately. PURPOSE This narrative review focuses on adequate pain strategies for various types of surgery. The respective techniques are described and examples of specific pain management strategies given. Advantages and disadvantages of techniques are discussed. This review can serve as a sort of empirical guideline and orientation for the reader to develop their own strategy as well as bringing surgeons up-to-date with the latest anesthetic techniques. CONCLUSION Pain is not less or less relevant in minimally invasive surgery. New hallmarks of a multimodal pain strategy are abdominal wall blocks, either as single shot or continuously. Minor open surgery is best performed under a combination of loco-regional blocks and continuous sedation. Abdominal wall blocks, NSAIDs, and short-acting opioids given by nurses or as PCA present the best multimodal pain strategy in abdominal surgery. Epidural analgesia and spinal anesthesia have become second-line options or are reserved for specific patient morbidities or surgical requirements.
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Affiliation(s)
- Thomas M Hemmerling
- Department of Anesthesia, McGill University, 1650 Cedar Avenue, Montreal, Canada. .,Division of Experimental Surgery, McGill University, Montreal, Canada. .,Department of Anesthesia, University of Montreal, CIUSSS Montreal-North, Montreal, Canada.
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9
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Ghabra H, Smith SA. Anesthesia for Urological Procedures. Anesthesiology 2018. [DOI: 10.1007/978-3-319-74766-8_76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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10
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Ding DY, Mahure SA, Mollon B, Shamah SD, Zuckerman JD, Kwon YW. Comparison of general versus isolated regional anesthesia in total shoulder arthroplasty: A retrospective propensity-matched cohort analysis. J Orthop 2017; 14:417-424. [PMID: 28794581 DOI: 10.1016/j.jor.2017.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 07/20/2017] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Intraoperative anesthetic typically consists of either general anesthesia (GA) or isolated regional anesthesia (RA). METHODS A retrospective propensity-matched cohort analysis on patients undergoing TSA was performed to determine differences between GA and RA in regard to patient population, complications, LOS and hospital readmission. RESULTS 4158 patients underwent TSA with GA or isolated RA. Propensity-matching resulted in 912 patients in each cohort. RA had lower overall in-hospital complications and greater homebound discharge disposition with lower 90-day readmission rates than GA. CONCLUSION After TSA, isolated RA was associated with lower in-hospital complications, readmission rates and odds of hospital readmission than GA.
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Affiliation(s)
- David Y Ding
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
| | - Siddharth A Mahure
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
| | - Brent Mollon
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
| | - Steven D Shamah
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
| | - Joseph D Zuckerman
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
| | - Young W Kwon
- NYU Hospital for Joint Diseases, Department of Orthopaedic Surgery, 301 East 17th Street, New York, NY 10003, United States
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Naghibi K, Saryazdi H, Kashefi P, Rohani F. The comparison of spinal anesthesia with general anesthesia on the postoperative pain scores and analgesic requirements after elective lower abdominal surgery: A randomized, double-blinded study. JOURNAL OF RESEARCH IN MEDICAL SCIENCES : THE OFFICIAL JOURNAL OF ISFAHAN UNIVERSITY OF MEDICAL SCIENCES 2013; 18:543-8. [PMID: 24516483 PMCID: PMC3897018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2012] [Revised: 10/16/2012] [Accepted: 12/10/2012] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to compare the postoperative pain scores and morphine requirements between spinal anesthesia (SA) with hyperbaric bupivacaine 0.5% and general anesthesia (GA) with 1 Minimal alveolar concentration minimal alveolar concentration (MAC) of isoflurane in 50% N2O and O2 after elective lower abdominal surgery. MATERIALS AND METHODS In this randomized clinical trial, 68 patients with American Society of Anesthesiologists (ASA) I or II undergoing lower abdominal surgery were randomly assigned to have elective lower abdominal surgery under SA (n = 34) or GA (n = 34). The SA group received 3 cc of 0.5% hyperbaric bupivacaine (15 mg), at L3-L4 interspace intrathecally and also 2 mic/kg fentanyl and 0.15 mg/kg morphine intravenously for intraoperative analgesia. In the GA group, induction of anesthesia was carried out with Na thiopental 6 mg/kg body weight, fentanyl 2 mic/kg body weight, morphine 0.15 mg/kg, and atracurium 0.6 mg/kg body weight, and then, trachea was intubated. The primary outcome was postoperative pain scores at rest and under stress on a visual analog scale and the secondary outcome was morphine requirement by the patients. Outcome measures were recorded at 2, 4, 6, 12, and 24 h postoperatively. The duration of postanesthesia care unit (PACU) and hospital stay were recorded. Intraoperative parameters, postoperative pain scores, complications, recovery time, and the duration of hospital stay at follow up were compared between the two groups. RESULTS Patients in SA group had significantly lower scores of a postoperative pain at rest (3.4 ± 1.6 and 4.1 ± 1.2 at 2 and 4 h postoperatively vs. 5.2 ± 1.5 and 5.8 ± 0.9 in the GA group with P < 0.05), but there were no significant differences between both groups for scores of postoperative pain at 6, 12, and 24 h. The amount of morphine requirement in 6 h postoperatively was significantly lower in the SA group (10.2 ± 4.3 mg vs. 15.6 ± 5.6 mg in the GA group with P < 0.05), but there were not significant differences between the two groups after 6 h postoperatively. The duration of PACU stay was shorter for the GA group than the SA group (75 ± 6 vs. 126 ± 12 min, P < 0.001), but there was no significant differences between the duration of hospital stay between the two groups (1.8 ± 0.6 vs. 2.1 ± 0.8 days). CONCLUSION Although in patients undergoing elective lower abdominal surgery with SA may have lower pain scores and also lower morphine requirement in the first 6 h postoperatively, but after that there were no significant differences between SA and GA regarding postoperative pain scores and analgesic requirements and so more attention should be given to their postoperation pain relief.
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Affiliation(s)
- Khosrou Naghibi
- Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Hamid Saryazdi
- Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Parviz Kashefi
- Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farnaz Rohani
- Department of Anesthesia and Intensive Care, Alzahra University Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
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[Anesthesia in endourological and robot-assisted interventions]. Anaesthesist 2012; 61:733-44; quiz 745-7. [PMID: 22875058 DOI: 10.1007/s00101-012-2047-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The improved drug therapy leads to increasingly older patients with complex comorbidities in the discipline of operative urology. Today, improved technical equipment provides new operational capabilities in the field of urology. The prone and lithotomy position during surgery leads to physiological changes that affect anesthesia management. The surgical risk of procedures such as transurethral surgery of the prostate or bladder is being altered by laser surgery and other new technologies. Although the incidence of transurethral resection (TUR) syndrome has been reduced in recent years, the intrusion of irrigation fluid still has to be considered during anesthesia. Robot-assisted surgery has successfully completed the experimental stage and is widely used so that new targets have to be challenged. Ureterorenoscopy is performed with flexible, small caliber ureteroscopes which even allow treatment of renal calculi under analgosedation within short time periods. Percutaneous nephrostomy and litholapaxy are still frequently performed in the prone position. With respect to the risks arising from patient positioning, supine or lateral positioning should be considered in individual cases. A good communication between the surgeon and anesthetist allows deviation from daily routine procedures if special indications require a modified approach. In conclusion, a profound knowledge of the (patho-)physiology of general anesthesia and endourological diseases enables anesthetists to provide a prospective type anesthesia, which should prevent the occurrence of life-threatening incidents.
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