The Value Of High Dose Frusemide In The Management Of 350 Open Prostatectomies

Abstract

Background: The use of frusemide in open and closed prostatectomy has provided a distinct advance over osmotic diuretics.
Objective: To report our experience in the use of high dose infusion of frusemide in the postoperative management of 350 open prostatectomy and discuss its benefits.
Patient and Methods: The study included 350 consecutive patients with benign prostatic enlargement who were managed with open prostatectomy and high dose frusemide infusion for bladder irrigation. The age ranged between 49 and 90; the mean age was 61 years. 330 (94.0%) patients presented with urine retention. Other associated medical and surgical conditions were adequately treated before, during and after prostatectomy. Suprapubic prostatectomy was performed on 319 (91.1%) patients while retropubic prostatectomy was on 31 (8.9%) patients. General anaesthesia was administered on 196 (54.6%), spinal analgesia on 139 (39.7%) and epidural analgesia on 15 (4.3%) patients. Blood transfusion, intravenous fluid and frusemide were given during and after operation to replace losses and maintain urine flow. A group of 100 consecutive prostatectomy were given Darrows solution, 1 litre in the first day and 1 litre in the second day following operation. Patients were carefully monitored during the 48 hours of intravenous fluid and frusemide infusion regime. Fluid intake, urine output, sodium and potassium losses in urine were studied in both group of patients. Frusemide infusion regime was carefully followed. Fluid intake regulated to be at least 500mls ahead of urine output during the infusion regime. Frusemide administration was discontinued at the end of the first 24 hours following operation and oral fluids commenced.
Results: Intraoperatively, 268 (76.6%) patients were transfused with one unit of blood each; 40 (11.4%) patients received 2 units of blood each while 42 (12.0%) patients did not require blood transfusion. The average daily urinary electrolyte losses were 450 mmol of sodium and 32 mmol of potassium. The levels of serum sodium and potassium remained within the normal range in all patients. In the first 24 hours fluid intake ranged between 5.5 and 8.5 litres while urine output ranged from 3.8 to 6.4 litres.
28 (8.0%) patients complained of nausea and 10 (2.9%) vomited each once following the bolus intravenous injection of 40mg of frusemide.
Two patients died on the 6th and 8th postoperative days respectively. Mortality was 0.6 percent.
Conclusion: The use of high dose frusemide infusion in open prostatectomy is simple to administer, safe, cost effective and not associated with significant potassium depletion.


Keywords: Open prostatectomy, Fursemide infusion, Postoperative management

Sahel Medical Journal Vol. 11 (1) 2008: pp. 28-33