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Spinal anesthesia tied to faster recovery after holmium laser enucleation of prostate in high risk patients
Spinal anesthesia provides greater hemodynamic stability and allows faster overall postoperative recovery with preferable pain management in patients undergoing Holmium laser enucleation of the prostate, finds a recent study.
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
BDS, MDS( Pedodontics and Preventive Dentistry)
Dr. Nandita Mohan is a practicing pediatric dentist with more than 5 years of clinical work experience. Along with this, she is equally interested in keeping herself up to date about the latest developments in the field of medicine and dentistry which is the driving force for her to be in association with Medical Dialogues. She also has her name attached with many publications; both national and international. She has pursued her BDS from Rajiv Gandhi University of Health Sciences, Bangalore and later went to enter her dream specialty (MDS) in the Department of Pedodontics and Preventive Dentistry from Pt. B.D. Sharma University of Health Sciences. Through all the years of experience, her core interest in learning something new has never stopped. She can be contacted at editorial@medicaldialogues.in. Contact no. 011-43720751
Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751