Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?

Rom A. Stevens, Marianne Mikat-Stevens, Robert Flanigan, W Waters, P. A.T. Furry, Taqdees Sheikh, Kere Frey, Mary Olson, Bruce Kleinman

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objectives. Return of bowel function after radical prostatectomy surgery may be the limiting factor in discharging these patients from the hospital. Recent studies have shown that postoperative epidural infusion of bupivacaine decreases time to return of bowel function compared with intravenous and epidural morphine in patients after abdominal surgery. This study focuses on the role of the intraoperative anesthetic technique on recovery of bowel function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing radical retropubic prostatectomy and pelvic lymphadenectomy. Methods. Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle relaxation and mechanical ventilation, followed by postoperative intravenous morphine patient-controlled analgesia) or group B (thoracic epidural anesthesia using bupivacaine, combined with 'light' general anesthesia using a laryngeal mask airway and spontaneous ventilation, followed by epidural morphine analgesia). Intra- and postoperative data were collected on blood loss, volumes of crystalloid and colloid infused, blood transfused, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of bowel function, quality of postoperative pain control, and time to discharge from hospital. Each patient underwent lower extremity venous ultrasonography to detect DVT. Results. Twenty-one patients received general anesthesia and 19 received combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to first flatus and first bowel movement were also shorter in this group. There were no significant differences in duration of anesthesia or surgery, quality of postoperative analgesia, side effects of analgesia, or time to discharge from hospital. There was no DVT detected in any patient. Conclusions. The combined anesthetic technique of thoracic epidural anesthesia and 'light' general anesthesia with spontaneous ventilation decreased intraoperative blood loss and shortened the time to return of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital discharge. There was no evidence of increased complications secondary to epidural anesthesia or of prolonged anesthetic time necessary to place epidural catheters.

Original languageEnglish (US)
Pages (from-to)213-218
Number of pages6
JournalUrology
Volume52
Issue number2
DOIs
StatePublished - Aug 1 1998

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Recovery of Function
Prostatectomy
Anesthetics
General Anesthesia
Epidural Anesthesia
Venous Thrombosis
Morphine
Bupivacaine
Analgesia
Ventilation
Endotracheal Anesthesia
Combined Anesthetics
Thorax
Anesthesia
Flatulence
Postoperative Hemorrhage
Patient-Controlled Analgesia
Laryngeal Masks
Muscle Relaxation
Epidural Analgesia

All Science Journal Classification (ASJC) codes

  • Urology

Cite this

Stevens, R. A., Mikat-Stevens, M., Flanigan, R., Waters, W., Furry, P. A. T., Sheikh, T., ... Kleinman, B. (1998). Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy? Urology, 52(2), 213-218. https://doi.org/10.1016/S0090-4295(98)00147-2

Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy? / Stevens, Rom A.; Mikat-Stevens, Marianne; Flanigan, Robert; Waters, W; Furry, P. A.T.; Sheikh, Taqdees; Frey, Kere; Olson, Mary; Kleinman, Bruce.

In: Urology, Vol. 52, No. 2, 01.08.1998, p. 213-218.

Research output: Contribution to journalArticle

Stevens, RA, Mikat-Stevens, M, Flanigan, R, Waters, W, Furry, PAT, Sheikh, T, Frey, K, Olson, M & Kleinman, B 1998, 'Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?', Urology, vol. 52, no. 2, pp. 213-218. https://doi.org/10.1016/S0090-4295(98)00147-2
Stevens, Rom A. ; Mikat-Stevens, Marianne ; Flanigan, Robert ; Waters, W ; Furry, P. A.T. ; Sheikh, Taqdees ; Frey, Kere ; Olson, Mary ; Kleinman, Bruce. / Does the choice of anesthetic technique affect the recovery of bowel function after radical prostatectomy?. In: Urology. 1998 ; Vol. 52, No. 2. pp. 213-218.
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abstract = "Objectives. Return of bowel function after radical prostatectomy surgery may be the limiting factor in discharging these patients from the hospital. Recent studies have shown that postoperative epidural infusion of bupivacaine decreases time to return of bowel function compared with intravenous and epidural morphine in patients after abdominal surgery. This study focuses on the role of the intraoperative anesthetic technique on recovery of bowel function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing radical retropubic prostatectomy and pelvic lymphadenectomy. Methods. Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle relaxation and mechanical ventilation, followed by postoperative intravenous morphine patient-controlled analgesia) or group B (thoracic epidural anesthesia using bupivacaine, combined with 'light' general anesthesia using a laryngeal mask airway and spontaneous ventilation, followed by epidural morphine analgesia). Intra- and postoperative data were collected on blood loss, volumes of crystalloid and colloid infused, blood transfused, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of bowel function, quality of postoperative pain control, and time to discharge from hospital. Each patient underwent lower extremity venous ultrasonography to detect DVT. Results. Twenty-one patients received general anesthesia and 19 received combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to first flatus and first bowel movement were also shorter in this group. There were no significant differences in duration of anesthesia or surgery, quality of postoperative analgesia, side effects of analgesia, or time to discharge from hospital. There was no DVT detected in any patient. Conclusions. The combined anesthetic technique of thoracic epidural anesthesia and 'light' general anesthesia with spontaneous ventilation decreased intraoperative blood loss and shortened the time to return of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital discharge. There was no evidence of increased complications secondary to epidural anesthesia or of prolonged anesthetic time necessary to place epidural catheters.",
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AB - Objectives. Return of bowel function after radical prostatectomy surgery may be the limiting factor in discharging these patients from the hospital. Recent studies have shown that postoperative epidural infusion of bupivacaine decreases time to return of bowel function compared with intravenous and epidural morphine in patients after abdominal surgery. This study focuses on the role of the intraoperative anesthetic technique on recovery of bowel function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patients undergoing radical retropubic prostatectomy and pelvic lymphadenectomy. Methods. Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle relaxation and mechanical ventilation, followed by postoperative intravenous morphine patient-controlled analgesia) or group B (thoracic epidural anesthesia using bupivacaine, combined with 'light' general anesthesia using a laryngeal mask airway and spontaneous ventilation, followed by epidural morphine analgesia). Intra- and postoperative data were collected on blood loss, volumes of crystalloid and colloid infused, blood transfused, duration of anesthesia and surgery, anesthetic and surgical complications, time to recovery of bowel function, quality of postoperative pain control, and time to discharge from hospital. Each patient underwent lower extremity venous ultrasonography to detect DVT. Results. Twenty-one patients received general anesthesia and 19 received combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to first flatus and first bowel movement were also shorter in this group. There were no significant differences in duration of anesthesia or surgery, quality of postoperative analgesia, side effects of analgesia, or time to discharge from hospital. There was no DVT detected in any patient. Conclusions. The combined anesthetic technique of thoracic epidural anesthesia and 'light' general anesthesia with spontaneous ventilation decreased intraoperative blood loss and shortened the time to return of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital discharge. There was no evidence of increased complications secondary to epidural anesthesia or of prolonged anesthetic time necessary to place epidural catheters.

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