Spinal anesthesia tied to faster recovery after holmium laser enucleation of prostate in high risk patients

The research is published in the Journal of Urology.

Thilo Westhofen and colleagues from the Department of Urology, University Hospital Großhadern, Ludwig-Maximilians-University Munich, Germany compared the perioperative management and functional outcome of spinal anesthesia (SpA) to general anesthesia (GA) in high-risk patients treated for lower urinary tract symptoms (LUTS) with Holmium laser enucleation of the prostate (HoLEP).

The authors conducted a retrospective analysis in which a propensity-score-matching of patients treated for lower urinary tract symptoms with risk patients treated for lower urinary tract symptoms with Holmium (n=300) in spinal anesthesia with ASA>2 (n=100), general anesthesia with ASA>2 (GA-high-risk) (n=100) or GA with ASA≤2 (GA-low-risk) (n=100) was performed.

The impact of anesthesiologic mode on perioperative anesthesiologic outcome, early functional outcome and treatment related adverse events (according to Clavien Dindo), was evaluated.

The study showed that the hypotensive episodes were significantly less frequent in the spinal anesthesia-cohort (9%) compared to the general anesthesia-high-risk cohort (32%) and the general anesthesia low-risk cohort (22%) (each p<0.05 respectively).

Spinal anesthesia patients showed a significantly shorter median time in post anesthesia care unit compared to general anesthesia high-risk patients with significant less referrals to Intermediate care unit (ICU) (1% vs. 9 %); (each p<0.05).

PACU-time (99min) and ICU referrals (0%) for GA-low-risk were lower than for both other cohorts. Postoperative requirement for analgesics was significantly lower in the spinal anesthesia cohort (2%), compared to both general anesthesia cohorts (74% and 61% respectively; p<0.05).

Furthermore, no significant difference was found regarding early functional outcome or treatment related adverse events.

As a result, the authors concluded that for patients undergoing Holmium laser enucleation of the prostate, spinal anesthesia provides greater hemodynamic stability and allows faster overall postoperative recovery with preferable pain management. Yielding a comparable functional outcome, it is a safe and efficient alternative to GA in high-risk patients.

https://doi.org/10.1016/j.urology.2021.04.078