At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .
The Effect of Epidural Versus General Anesthesia on Postoperative Pain and Analgesic Requirements in Patients Undergoing Radical Prostatectomy
Background Although preemptive analgesia has been shown to decrease postinjury pain in animals , studies in humans have provided controversial results . The authors studied whether surgical epidural anesthesia with local anesthetics could affect postoperative pain and analgesic dem and s , when compared with general anesthesia . Methods Male patients scheduled for radical retropubic prostatectomy were r and omly assigned to receive  epidural anesthesia only ( EA , n = 34 ) , combined epidural and general anesthesia ( EG , n = 32 ) , or general anesthesia only ( GA , n = 30 ) . A lumbar epidural catheter was inserted and tested in all patients . In the EA group , an induction dose of 0.25 ml/kg epidural bupivacaine ( 0.5 % ) was followed during surgery by a continuous infusion of 0.1 ml.kg–1.h–10.125 % bupivacaine . In the EG group , 0.2 ml/kg epidural bupivacaine ( 0.5 % ) was injected after induction of general anesthesia but before surgery , followed by epidural infusion of 0.1 ml.kg–1.h–10.125 % bupivacaine . In the GA group , anesthesia was maintained with morphine , isoflurane , and N2O . Epidural patient-controlled analgesia ( PCA ) was provided with bupivacaine and fentanyl for all patients in the postoperative period . Postoperative pain scores and analgesic requirements were examined and compared between groups every 4–8 h for 3–5 postoperative days . Results Intraoperatively , EA patients received significantly more epidural bupivacaine than EG patients ( 129 ± 6 mg vs. 98 ± 6 mg , respectively . Recovery room median residual sensory level in EA patients ( T6 ± 2 ) was significantly higher than in EG patients ( T10 ± 2 ) . PCA dem and was greater in the GA and EG groups when compared with the EA group in postoperative days 2 ( 126 ± 9 ml , 112 ± 9 ml , 90 ± 6 ml , respectively ; P = 0.01 ) and 3 ( 89 ± 10 ml , 83 ± 9 ml , 48 ± 5 respectively ; P = 0.005 ) . There was no difference in PCA dem and between the GA and EG groups in the postoperative period . No significant clinical differences in postoperative mean pain scores were recorded in the first 5 days after surgery in the three anesthetic groups ( range 0–2/10 ) . Conclusions In patients undergoing lower abdominal surgery , the neuraxial blockade and surgical anesthesia achieved by epidural local anesthetics was associated with decreased postoperative analgesic dem and s. Lower postoperative analgesic requirements in the EA group , when compared with both the EG and GA groups , indicate that : ( 1 ) EA patients had less postoperative pain , and ( 2 ) an efficient intraoperative blockade of noxious afferent signals to the central nervous system is fundamental in reducing postoperative pain
At the moment , the evidence available can not prove that neuraxial anesthesia is more effective and safer than general anesthesia for urological surgery .
There were insufficient data to pool the results relating to mortality , stroke , myocardial infa rct ion , length of hospitalization , quality of life , degree of satisfaction , postoperative cognitive dysfunction and blood transfusion requirements
CONTEXT AND OBJECTIVE Choosing the best anesthetic technique for urological surgery with the aim of mortality reduction remains controversial .
The objective here was to compare the effectiveness and safety of neuraxial anesthesia versus general anesthesia for urological surgery .