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Increasing use of regional anaesthesia for prostatectomy – University of Benin Teaching Hospital experience
Abstract
Introduction: Regional anaesthesia is widely used for urological procedures. It may be better tolerated in the elderly, avoiding the cardiovascular and respiratory depressant effects of general anaesthesia, provided that there are no contraindications. Bladder outflow obstruction due to benign prostatic hyperplasia is common in the elderly. Our aim was to determine the preference of neuraxial block technique for prostatectomy in our institution.
Patients and methods: This was a prospective study of patients scheduled for elective prostatectomy with ages ranging from 49 to 94 years for a period of eighteen months. They were seen by anaesthetists, two or three days before surgery and all received oral diazepam, 5mg on the morning of surgery. Choice of anaesthesia was determined by the attending anaesthetist. Standard questionnaires were used to document patients’ characteristics, technique of anaesthesia, intraoperative and postoperative complications, management and outcome.
Results: One hundred and twelve male patients aged 49–94 years (mean age 67.38 ± 11.33) were recruited in the study. Eighty six (77%) patients were 60 years and above while 26 (23%) were below 60 years. Intercurrent medical diseases were common in patients above 60 years. Fifty two patients (46.4%) had intercurrent medical diseases, with hypertension being the leading among them [31(59.6%)] followed by diabetes mellitus [7(13.5%)]. Seventy six patients (68%) had suprapubic transvesical prostatectomy, 21(19%) had retropubic (Millin) anaesthesia while 15 (13%) had transurethral resection of the prostate. The techniques of anaesthesia used were general for 6 (5%) patients, epidural anaesthesia for 39 (35%) patients and spinal anaesthesia for 67 (60%) patients. Intraoperative hypotension occurred in 17 (56.6%) patients in the spinal group and in 3 (21.42%) in the epidural group. The incidence of intraoperative and recovery room complications was higher in the spinal group than in the epidural group, 32 (63%) compared to 19 (37%). The difference was not statistically significant. P = 0.5257, OR = 0.6933, CI: 0.2977 – 1.107. Conclusion: We conclude that neuraxial block technique for prostatectomy has gained overwhelming popularity in our institution.
Patients and methods: This was a prospective study of patients scheduled for elective prostatectomy with ages ranging from 49 to 94 years for a period of eighteen months. They were seen by anaesthetists, two or three days before surgery and all received oral diazepam, 5mg on the morning of surgery. Choice of anaesthesia was determined by the attending anaesthetist. Standard questionnaires were used to document patients’ characteristics, technique of anaesthesia, intraoperative and postoperative complications, management and outcome.
Results: One hundred and twelve male patients aged 49–94 years (mean age 67.38 ± 11.33) were recruited in the study. Eighty six (77%) patients were 60 years and above while 26 (23%) were below 60 years. Intercurrent medical diseases were common in patients above 60 years. Fifty two patients (46.4%) had intercurrent medical diseases, with hypertension being the leading among them [31(59.6%)] followed by diabetes mellitus [7(13.5%)]. Seventy six patients (68%) had suprapubic transvesical prostatectomy, 21(19%) had retropubic (Millin) anaesthesia while 15 (13%) had transurethral resection of the prostate. The techniques of anaesthesia used were general for 6 (5%) patients, epidural anaesthesia for 39 (35%) patients and spinal anaesthesia for 67 (60%) patients. Intraoperative hypotension occurred in 17 (56.6%) patients in the spinal group and in 3 (21.42%) in the epidural group. The incidence of intraoperative and recovery room complications was higher in the spinal group than in the epidural group, 32 (63%) compared to 19 (37%). The difference was not statistically significant. P = 0.5257, OR = 0.6933, CI: 0.2977 – 1.107. Conclusion: We conclude that neuraxial block technique for prostatectomy has gained overwhelming popularity in our institution.
