DOES THE CHOICE OF ANESTHETIC TECHNIQUE AFFECT THE RECOVERY OF BOWEL FUNCTION AFTER RADICAL PROSTATECTOMY

Objectives. Return of bowel function after radical prostatectomy surge ry may be the limiting factor in discharging these patients from the h ospital. Recent studies have shown that postoperative epidural infusio n of bupivacaine decreases time to return of bower function compared w ith intravenous and epidural morphine in patients after abdominal surg ery. This study focuses on the role of the intraoperative anesthetic t echnique on recovery of bower function, intraoperative blood loss, and the incidence of postoperative deep venous thrombosis (DVT) in patien ts undergoing radical retropubic prostatectomy and pelvic lymphadenect omy. Methods. Forty patients undergoing prostatectomy were randomized to either group A (general endotracheal anesthesia, including muscle r elaxation and mechanical ventilation, followed by postoperative intrav enous morphine patient-controlled analgesia) or group B (thoracic epid ural anesthesia using bupivacaine, combined with ''light'' general ane sthesia using a laryngeal mask airway and spontaneous ventilation, fol lowed by epidural morphine analgesia). Intra- and postoperative data w ere collected on blood loss, volumes of crystalloid and colloid infuse d, blood transfused, duration of anesthesia and surgery, anesthetic an d surgical complications, time to recovery of bower function, quality of postoperative pain control, and time to discharge from hospital. Ea ch patient underwent lower extremity venous ultrasonography to detect DVT. Results. Twenty-one patients received general anesthesia and 19 r eceived combined epidural and general anesthesia. Intraoperative blood loss was significantly lower in the epidural group, and times to firs t flatus and first bowel movement were also shorter in this group. The re were no significant differences in duration of anesthesia or surger y, quality of postoperative analgesia, side effects of analgesia, or t ime to discharge from hospital. There was no DVT detected in any patie nt. Conclusions. The combined anesthetic technique of thoracic epidura l anesthesia and ''light'' general anesthesia with spontaneous ventila tion decreased intraoperative blood loss and shortened the time to ret urn of bowel function. However, this earlier return of bowel function was not great enough to realize a difference in time to hospital disch arge. There was no evidence of increased complications secondary to ep idural anesthesia or of prolonged anesthetic time necessary to place e pidural catheters. UROLOGY 52: 213-218, 1998. (C) 1998, Elsevier Scien ce Inc. All rights reserved.