Neuraxial anesthesia versus general anesthesia for urological surgery
systematic review
Keywords:
Mortality, Anesthesia, general, Anesthesia, epidural, Anesthesia, spinal, Review [publication type]Abstract
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. DESIGN AND SETTING: Systematic review, Universidade Federal de Alagoas. METHODS: We searched the Cochrane Central Register of Controlled Trials in the Cochrane Library (Issue 10, 2012), Medline via PubMed (1966 to October 2012), Lilacs (1982 to October 2012), SciELO and EMBASE (1974 to October 2012). The reference lists of the studies included and of one systematic review in the same field were also analyzed. The studies included were randomized controlled trials (RCT) that analyzed neuraxial anesthesia and general anesthesia for urological surgery. RESULTS: The titles and abstracts of 2720 articles were analyzed. Among these, 16 studies were identified and 11 fulfilled the inclusion criteria. One RCT was published twice. The study validity was: Jadad score > 3 in one RCT; seven RCTs with unclear risk of bias as the most common response; and five RCTs not fulfilling half of the Delphi list items. The frequency of mortality was not significant between study groups in three RCTs. Meta-analysis was not performed. CONCLUSION: At the moment, the evidence available cannot 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 infarction, length of hospitalization, quality of life, degree of satisfaction, postoperative cognitive dysfunction and blood transfusion requirements.
Downloads
References
Barbosa FT, Castro AA, Miranda CT. Anestesia neuroaxial comparada à anestesia geral para procedimentos na metade inferior do corpo: revisão sistemática de revisões sistemáticas [Neuraxial anesthesia compared to general anesthesia for procedures on the lower half of the body: systematic review of systematic reviews]. Rev Bras Anestesiol. 2012;62(2):239-43.
Rodgers A, Walker N, Schug S, et al. Reduction of postoperative mortality and morbidity with epidural or spinal anaesthesia: results from overview of randomised trials. BMJ. 2000;321(7275):1493.
Tiong HY, Liew LC, Samuel M, Consigliere D, Esuvaranathan K. A meta- analysis of local anesthesia for transrectal ultrasound-guided biopsy of the prostate. Prostate Cancer Prostatic Dis. 2007;10(2):127-36.
Higgins JPT, Green S. Cochrane Handbook for Systematic Reviews of Interventions. The Cochrane Collaboration; 2011. Available from: www. cochrane-handbook.org. Accessed in 2013 (Feb 13).
Moher D, Liberati A, Tetzlaff J, Altman DG; PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097.
Jadad AR, Moore RA, Carroll D, et al. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17(1):1-12.
Verhagen AP, de Vet HC, de Bie RA, et al. The Delphi list: a criteria list for quality assessment of randomized clinical trials for conducting systematic reviews developed by Delphi consensus. J Clin Epidemiol. 1998;51(12):1235-41.
Shnaider I, Chung F. Outcomes in day surgery. Curr Opin Anaesthesiol. 2006;19(6):622-9.
Rothwell PM. External validity of randomised controlled trials: “to whom do the results of this trial apply?”. Lancet. 2005;365(9453):82-93.
Cochrane IMS. ReviewManager (RevMan). Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration; 2011. Available from: http://ims.cochrane.org/revman/. Accessed in 2013 (Feb 13).
Karacalar S, Bilen CY, Sarihasan B, Sarikaya S. Spinal-epidural anesthesia versus general anesthesia in the management of percutaneous nephrolithotripsy. J Endourol. 2009;23(10):1591-7.
Tikuisis R, Miliauskas P, Samalavicius NE, Zurauskas A, Sruogis A. Epidural and general anesthesia versus general anesthesia in radical prostatectomy. Medicina (Kaunas). 2009;45(10):772-7.
O’Connor PJ, Hanson J, Finucane BT. Induced hypotension with epidural/ general anesthesia reduces transfusion in radical prostate surgery. Can J Anaesth. 2006;53(9):873-80.
Ozyuvaci E, Altan A, Karadeniz T, et al. General anesthesia versus epidural and general anesthesia in radical cystectomy. Urol Int. 2005;74(1):62-7.
Salonia A, Crescenti A, Suardi N, et al. General versus spinal anesthesia in patients undergoing radical retropubic prostatectomy: results of a prospective, randomized study. Urology. 2004;64(1):95-100.
Brown DR, Hoter RE, Patterson DE, et al. Intrathecal anesthesia and recovery from radical prostatectomy: a prospective, randomized, controlled trial. Anesthesiology. 2004;100(4):926-34.
Dauri M, Costa F, Servetti S, et al. Combined general and epidural anesthesia with ropivacaine for renal transplantation. Minerva Anestesiol. 2003;69(12):873-84.
Shir Y, Raja SN, Frank SM, Brendler CB. Intraoperative blood loss during radical retropubic prostatectomy: epidural versus general anesthesia. Urology. 1995;45(6):993-9.
Shir Y, Raja SN, Frank SM. The effect of epidural versus general anesthesia on postoperative pain and analgesic requirements in patients undergoing radical prostatectomy. Anesthesiology. 1994;80(1):49-56.
Hendolin H, Alhava E. Effect of epidural versus general anaesthesia on peroperative blood loss during retropubic prostatectomy. Int Urol Nephrol. 1982;14(4):399-405.
McGowan SW, Smith GF. Anaesthesia for transurethral prostatectomy. A comparison of spinal intradural analgesia with two methods of general anaesthesia. Anaesthesia. 1980;35(9):847-53.
Henry DA, Wilson A. Meta-analysis. Part 1: An assessment of its aims, validity and reliability. Med J Aust. 1992;156(1):31-8.
Gauss A, Jahn SK, Eberhart LH, et al. Kardioprotektion durch thorakale Periduralanästhesie?: Metaanalyse [Cardioprotection by thoracic epidural anesthesia?: meta-analysis]. Anaesthesist. 2011;60(10):950-62.
Myles PS, Hunt JO, Fletcher H, et al. Relation between quality of recovery in hospital and quality of life at 3 months after cardiac surgery. Anesthesiology. 2001;95(4):862-7.
Silbert B, Evered L, Scott DA. Cognitive decline in the elderly: is anaesthesia implicated? Best Pract Res Clin Anaesthesiol. 2011;25(3):379-93.
Bilotta F, Doronzio A, Stazi E, et al. Early postoperative cognitive dysfunction and postoperative delirium after anaesthesia with various hypnotics: study protocol for a randomised controlled trial—the PINOCCHIO trial. Trials. 2011;12:170.
