Combined anaesthesia with epidural catheter. A retrospective analysis of the perioperative course in patients under-going radical prostatectomy

Patients requiring radical prostatectomy (rPE), including retroperitoneal l ymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in therms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hosp ital were retrospectively reviewed. Patients were divided in those who rece ived: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA)+GA or, 3. thoracic epidural anaesthesia (TEA)+GA. General anaesthesia was performed as balanced anaesthesia, and epidural adm inistered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8- 12 ml/h. In terms of intra- and postoperative numbers of tachycardic and hypertensiv e episodes, a reduced stress response was observed under epidural anaesthes ia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointe stinal motility was found earlier ([h] GA: 50.6+/-11.1/LEA: 39.3+/-13.6/TEA :33.8+/-13.0). Furthermore, a trend to rarer phases of postoperative vomiti ng and a significant decrease of in hospital stay of about one day ([d] GA: 12.4+/-5.8/LEA:11.1+/-3.1/TEA: 11.5+/-3.8) was observed. The duration of p ersonnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9+/-43.5/LEA: 238.2+/-41.8/TEA: 227.0+/-46.2), but ICU sta w as shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO(2) and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.