Intrathecal Anesthesia and Recovery from Radical Prostatectomy: A Prospective, Randomized, Controlled Trial

Daniel R. Brown, Roger E. Hofer, David E. Patterson, Paul J. Fronapfel, Pamela M. Maxson, Bradly J. Narr, John H. Eisenach, Michael L. Blute, Darrell R. Schroeder, David Oman Warner

Research output: Contribution to journalArticle

35 Citations (Scopus)

Abstract

Background: Previous studies suggest that intraoperative anesthetic care may influence postoperative pain and recovery from surgery. The authors tested the hypothesis that the addition of intrathecal analgesia to general anesthesia would improve long-term functional status and decrease pain in patients undergoing radical retropubic prostatectomy. Methods: One hundred patients received either general anesthesia supplemented with intravenous fentanyl or general anesthesia preceded by intrathecal administration of bupivacaine (15 mg), clonidine (75 μg), and morphine (0.2 mg). Patients and providers were masked to treatment assignment. All patients received multimodal pain management postoperatively. Primary outcomes included pain and functional status over the first 12 postoperative weeks. Results: Patients receiving intrathecal analgesia required more intravenous fluids and vasopressors intraoperatively. Pain was well controlled throughout the study (mean numerical pain scores < 3 in both groups at all times studied). Intrathecal analgesia decreased pain and supplemental intravenous morphine use over the first postoperative day but increased the frequency of pruritus. Pain and functional status after discharge from the hospital did not differ between groups. Intrathecal analgesia significantly decreased the duration of hospital stay (from 2.8 ± 2.0 to 2.1 ± 0.5 days; P < 0.01) as a result of five patients in the control group who stayed in the hospital more than 3 days. Conclusions: The benefits of improved immediate analgesia and decreased morphine requirements resulting from intrathecal analgesia must be weighed against factors such as pruritus, increased intraoperative requirement for fluids and vasopressors, and resources needed to implement this modality. Further studies are needed to determine the significance of the decrease in duration of hospital stay.

Original languageEnglish (US)
Pages (from-to)926-934
Number of pages9
JournalAnesthesiology
Volume100
Issue number4
DOIs
StatePublished - Apr 2004
Externally publishedYes

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Prostatectomy
Analgesia
Anesthesia
Randomized Controlled Trials
Pain
General Anesthesia
Morphine
Pruritus
Length of Stay
Intraoperative Care
Intravenous Anesthesia
Bupivacaine
Clonidine
Fentanyl
Pain Management
Postoperative Pain
Anesthetics
Control Groups

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Intrathecal Anesthesia and Recovery from Radical Prostatectomy : A Prospective, Randomized, Controlled Trial. / Brown, Daniel R.; Hofer, Roger E.; Patterson, David E.; Fronapfel, Paul J.; Maxson, Pamela M.; Narr, Bradly J.; Eisenach, John H.; Blute, Michael L.; Schroeder, Darrell R.; Warner, David Oman.

In: Anesthesiology, Vol. 100, No. 4, 04.2004, p. 926-934.

Research output: Contribution to journalArticle

Brown, DR, Hofer, RE, Patterson, DE, Fronapfel, PJ, Maxson, PM, Narr, BJ, Eisenach, JH, Blute, ML, Schroeder, DR & Warner, DO 2004, 'Intrathecal Anesthesia and Recovery from Radical Prostatectomy: A Prospective, Randomized, Controlled Trial', Anesthesiology, vol. 100, no. 4, pp. 926-934. https://doi.org/10.1097/00000542-200404000-00024
Brown, Daniel R. ; Hofer, Roger E. ; Patterson, David E. ; Fronapfel, Paul J. ; Maxson, Pamela M. ; Narr, Bradly J. ; Eisenach, John H. ; Blute, Michael L. ; Schroeder, Darrell R. ; Warner, David Oman. / Intrathecal Anesthesia and Recovery from Radical Prostatectomy : A Prospective, Randomized, Controlled Trial. In: Anesthesiology. 2004 ; Vol. 100, No. 4. pp. 926-934.
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abstract = "Background: Previous studies suggest that intraoperative anesthetic care may influence postoperative pain and recovery from surgery. The authors tested the hypothesis that the addition of intrathecal analgesia to general anesthesia would improve long-term functional status and decrease pain in patients undergoing radical retropubic prostatectomy. Methods: One hundred patients received either general anesthesia supplemented with intravenous fentanyl or general anesthesia preceded by intrathecal administration of bupivacaine (15 mg), clonidine (75 μg), and morphine (0.2 mg). Patients and providers were masked to treatment assignment. All patients received multimodal pain management postoperatively. Primary outcomes included pain and functional status over the first 12 postoperative weeks. Results: Patients receiving intrathecal analgesia required more intravenous fluids and vasopressors intraoperatively. Pain was well controlled throughout the study (mean numerical pain scores < 3 in both groups at all times studied). Intrathecal analgesia decreased pain and supplemental intravenous morphine use over the first postoperative day but increased the frequency of pruritus. Pain and functional status after discharge from the hospital did not differ between groups. Intrathecal analgesia significantly decreased the duration of hospital stay (from 2.8 ± 2.0 to 2.1 ± 0.5 days; P < 0.01) as a result of five patients in the control group who stayed in the hospital more than 3 days. Conclusions: The benefits of improved immediate analgesia and decreased morphine requirements resulting from intrathecal analgesia must be weighed against factors such as pruritus, increased intraoperative requirement for fluids and vasopressors, and resources needed to implement this modality. Further studies are needed to determine the significance of the decrease in duration of hospital stay.",
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T2 - A Prospective, Randomized, Controlled Trial

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AU - Fronapfel, Paul J.

AU - Maxson, Pamela M.

AU - Narr, Bradly J.

AU - Eisenach, John H.

AU - Blute, Michael L.

AU - Schroeder, Darrell R.

AU - Warner, David Oman

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N2 - Background: Previous studies suggest that intraoperative anesthetic care may influence postoperative pain and recovery from surgery. The authors tested the hypothesis that the addition of intrathecal analgesia to general anesthesia would improve long-term functional status and decrease pain in patients undergoing radical retropubic prostatectomy. Methods: One hundred patients received either general anesthesia supplemented with intravenous fentanyl or general anesthesia preceded by intrathecal administration of bupivacaine (15 mg), clonidine (75 μg), and morphine (0.2 mg). Patients and providers were masked to treatment assignment. All patients received multimodal pain management postoperatively. Primary outcomes included pain and functional status over the first 12 postoperative weeks. Results: Patients receiving intrathecal analgesia required more intravenous fluids and vasopressors intraoperatively. Pain was well controlled throughout the study (mean numerical pain scores < 3 in both groups at all times studied). Intrathecal analgesia decreased pain and supplemental intravenous morphine use over the first postoperative day but increased the frequency of pruritus. Pain and functional status after discharge from the hospital did not differ between groups. Intrathecal analgesia significantly decreased the duration of hospital stay (from 2.8 ± 2.0 to 2.1 ± 0.5 days; P < 0.01) as a result of five patients in the control group who stayed in the hospital more than 3 days. Conclusions: The benefits of improved immediate analgesia and decreased morphine requirements resulting from intrathecal analgesia must be weighed against factors such as pruritus, increased intraoperative requirement for fluids and vasopressors, and resources needed to implement this modality. Further studies are needed to determine the significance of the decrease in duration of hospital stay.

AB - Background: Previous studies suggest that intraoperative anesthetic care may influence postoperative pain and recovery from surgery. The authors tested the hypothesis that the addition of intrathecal analgesia to general anesthesia would improve long-term functional status and decrease pain in patients undergoing radical retropubic prostatectomy. Methods: One hundred patients received either general anesthesia supplemented with intravenous fentanyl or general anesthesia preceded by intrathecal administration of bupivacaine (15 mg), clonidine (75 μg), and morphine (0.2 mg). Patients and providers were masked to treatment assignment. All patients received multimodal pain management postoperatively. Primary outcomes included pain and functional status over the first 12 postoperative weeks. Results: Patients receiving intrathecal analgesia required more intravenous fluids and vasopressors intraoperatively. Pain was well controlled throughout the study (mean numerical pain scores < 3 in both groups at all times studied). Intrathecal analgesia decreased pain and supplemental intravenous morphine use over the first postoperative day but increased the frequency of pruritus. Pain and functional status after discharge from the hospital did not differ between groups. Intrathecal analgesia significantly decreased the duration of hospital stay (from 2.8 ± 2.0 to 2.1 ± 0.5 days; P < 0.01) as a result of five patients in the control group who stayed in the hospital more than 3 days. Conclusions: The benefits of improved immediate analgesia and decreased morphine requirements resulting from intrathecal analgesia must be weighed against factors such as pruritus, increased intraoperative requirement for fluids and vasopressors, and resources needed to implement this modality. Further studies are needed to determine the significance of the decrease in duration of hospital stay.

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