Prospective observational study on caudal epidural block for transurethral resection of prostate in patients with comorbidities

Authors

  • Bandana Paudel Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700
  • Sumitra Paudel Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700
  • Chitta Ranjan Das Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700

DOI:

https://doi.org/10.3126/jsan.v3i2.15617

Keywords:

Caudal anaesthesia, Comorbidities, elderly, Transurethral Resection of Prostate

Abstract

Background: The most important goal of anaesthesia for geriatric patients with comorbid diseases is to maintain normal homoeostasis of different systems during and after surgery. This prospective study was conducted to evaluate the success rate and associated complications of the caudal epidural block for transurethral resection of prostate in elderly patients with comorbid diseases.

Methods: This is a prospective study of a cohort of 100 elderly patients posted for transurethral resection of prostate with comorbid diseases belonging to American Society of anaesthesiologists physical status II, III and IV over a period of 1 year from April 2015 to April 2016. Standard recommended technique for caudal epidural block was followed. Time of onset, spread, duration of analgesia, intensity of block, complications, and unwanted effects were noted.

Results: The mean age was 73.5+-7.69. Eighty-two percent patients belonged to ASA III and IV grade. The majority (87%) had excellent to a good quality of anaesthesia with no motor block. 83% of patients had the onset of analgesia between 5-15 minutes and 78% had a duration between 90-130 minutes. Three patients had patchy analgesia and they were considered as a failure. No death was encountered in the study.

Conclusion: Caudal epidural block is a safe, effective anaesthetic technique for transurethral resection of the prostate in elderly with comorbid diseases of other systems.

Author Biographies

Bandana Paudel, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700

Lecturer, Department of Anesthesiology,Critical Care and Pain Management

Sumitra Paudel, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700

Intern, Nobel Medical college Teaching Hospital

Chitta Ranjan Das, Nobel Medical College and Teaching Hospital, Kanchanbari, Biratnagar, Morang 56700

Prof. and HOD,Department of Anesthesiology,Critical Care and Pain Management

References

<ol>
<li>O Donnell AM, Foo IT. Anaesthesia for transurethral resection of the prostate. Continuing Education in Anaesthesia, Critical Care &amp; Pain 2009;9:92-6. <a href="http://dx.doi.org/10.1093/bjaceaccp/mkp012">http://dx.doi.org/10.1093/bjaceaccp/mkp012</a></li>
<li>Balzarro M, Ficarra V, Bartoloni A, Tallarigo C, Malossini G. The pathophysiology, diagnosis and therapy of the transurethral resection of the prostate syndrome. Urol Int 2001;66:121-6. <a href="http://dx.doi.org/10.1159/000056589">http://dx.doi.org/10.1159/000056589</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/11316971">[PMid:11316971]</a></li>
<li>Shrestha BM, Prasopshanti K, Matanhelia SS, Peeling WB. Blood loss during and after transurethral resection of prostate: A prospective study. Kathmandu Univ Med J (KUMJ) 2008;6:329-34. <a href="http://www.ncbi.nlm.nih.gov/pubmed/20071814">[PMid:20071814]</a></li>
<li>Bowman GW, Hoerth JW, McGlothlen JS, Magee PJ, Mendenhall IE, Sonnenberg G, et al. Anesthesia for transurethral resection of the prostate: spinal or general? AANA Journal 1981;49:63-8. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7234316">[PMid:7234316]</a></li>
<li>Edwards ND, Callaghan LC, White T, Reilly CS. Perioperative myocardial ischaemia in patients undergoing transurethral surgery: a pilot study comparing general with spinal anaesthesia. Br J Anaesth 1995;74:368-72. <a href="http://dx.doi.org/10.1093/bja/74.4.368">http://dx.doi.org/10.1093/bja/74.4.368</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/7734251">[PMid:7734251]</a></li>
<li>Okeke LI. Experience with caudal block regional anaesthesia for transurethral resection of the prostate gland. West Afr J Med 2002;21:280-1. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12665263">[PMid:12665263]</a></li>
<li>Horlocker TT, Wedel DJ, Rowlingson JC, Enneking FK, Kopp SL, Benzon HT, et al. Regional anaesthesia in the patient receiving antithrombotic or thrombolytic therapy. American Society of Regional Anaesthesia and pain medicine Evidence Based Guidelines. Reg Anaesth pain med 2010;35:64-101. <a href="http://dx.doi.org/10.1097/AAP.0b013e3181c15c70">http://dx.doi.org/10.1097/AAP.0b013e3181c15c70</a></li>
<li>Crighton IM, Barry BP, Hobbs GJ. A study of the anatomy of the caudal space using magnetic resonance imaging. Br J anaesth 1997;78:391-5. <a href="http://dx.doi.org/10.1093/bja/78.4.391">http://dx.doi.org/10.1093/bja/78.4.391</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/9135359">[PMid:9135359]</a></li>
<li>Djokovic JL, Hedley-Whyte J. Prediction of Outcome of Surgery and Anesthesia in Patients over 80. JAMA 1979;21:2301-6. <a href="http://dx.doi.org/10.1001/jama.1979.03300210027016">http://dx.doi.org/10.1001/jama.1979.03300210027016</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/490827">[PMid:490827]</a></li>
<li>Rostomashvili ET, Kostiuchenko AL, Stoiko I. Sacral epidural anesthesia in operations for varicose veins of the lower extremities. Vestnik khirurgii imeni II Grekova 1994;152:104. <a href="http://www.ncbi.nlm.nih.gov/pubmed/7740664">[PMid:7740664]</a></li>
<li>Yadav SS, Gupta S, Choudhary B. A clinical study of caudal epidural anaesthesia for transurethral resection of prostate. JEMDS 2015;4:10309-20. <a href="http://dx.doi.org/10.14260/jemds/2015/1485">http://dx.doi.org/10.14260/jemds/2015/1485</a></li>
<li>Adams RC, Lundy JS, Seldon TH. Continuous caudal anaesthesia or analgesia: A consideration of the technique, various uses and some possible dangers. JAMA 1943;122:152. <a href="http://dx.doi.org/10.1001/jama.1943.02840200008002">http://dx.doi.org/10.1001/jama.1943.02840200008002</a></li>
<li>Wilder RJ, Fishbein RH. Operative Experience with Patients over 80 Years of Age. Surg Gynecol Obstet 1961;113:205-12. <a href="http://www.ncbi.nlm.nih.gov/pubmed/13785249">[PMid:13785249]</a></li>
<li>Bhattacharyya S, Bisai S, Biswas H, Tiwary MK, Mallik S, Saha SM. Regional anesthesia in transurethral resection of prostate (TURP) surgery: A comparative study between saddle block and subarachnoid block. Saudi J Anaesth 2015;9:268-71. <a href="http://dx.doi.org/10.4103/1658-354X.158497">http://dx.doi.org/10.4103/1658-354X.158497</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/26240544">[PMid:26240544]</a> <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4478818/">[PMCid:PMC4478818]</a></li>
<li>Kose EA, Ozturk A, Ates G, Apan A. Caudal epidural block for elderly patients who have limited cardiac reserve. Turk J Med Sci 2012;42:1347-51.</li>
<li>Sicard A. Les injections medicamenteuses extra-durales par voie sacrococcygienne. Compt Rend Soc De Biol 1901;53:396-8.</li>
<li>Cathelin F. Une nouvelle voie d'injection rachidienne: methode des injections epidurales par le procede du canal sacre-applications a l'homme. Compt Rend Soc De Biol 1901;53:452-3.</li>
<li>Rushman GB, Davies NJH, Jeremy N, Cashman J, Lee A, Atkinson RS. Lees Synopsis of Anaesthesia. Oxford: Butterworth-Heinemann, 1999.</li>
<li>Hingson RA, Edwards WB. Continuous caudal anesthesia during labor and delivery. Curr Res Anesth Analg 1942;21:301-11. <a href="http://dx.doi.org/10.1213/00000539-194201000-00072">http://dx.doi.org/10.1213/00000539-194201000-00072</a></li>
<li>Mukherjee D, Eagle KA. Perioperative cardiac assessment for non cardiac surgery:eight steps to the best possible outcome. Circulation 2003;107:2771-4. <a href="http://dx.doi.org/10.1161/01.CIR.0000072248.24921.D6">http://dx.doi.org/10.1161/01.CIR.0000072248.24921.D6</a> <a href="http://www.ncbi.nlm.nih.gov/pubmed/12796413">[PMid:12796413]</a></li>
</ol>

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Published

2016-09-17

How to Cite

Paudel, B., Paudel, S., & Das, C. R. (2016). Prospective observational study on caudal epidural block for transurethral resection of prostate in patients with comorbidities. Journal of Society of Anesthesiologists of Nepal, 3(2), 74-79. https://doi.org/10.3126/jsan.v3i2.15617

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Original Article