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AMBULATORY ANESTHESIA

An Evaluation of General and Spinal Anesthesia Techniques for Prostate Brachytherapy in a Day Surgery Setting

Ron Flaishon, MD^*, Perla Ekstein, MD^*, Haim Matzkin, MD, and Avi A. Weinbroum, MD^*

Departments of *Anesthesiology and Critical Care Medicine, Urology, Day Surgery, and Post-Anesthesia Care Units, Tel Aviv Sourasky Medical Center and the Sackler Faculty of Medicine, Tel Aviv University, Israel

Address correspondence and reprint requests to Avi A. Weinbroum, MD, Post-Anesthesia Care Unit, Tel Aviv Sourasky Medical Center 6, Weizmann St., Tel Aviv 64239, Israel. Address e-mail to draviw{at}tasmc.heatlh.gov.il.

We evaluated four anesthetic techniques for transperineal brachytherapy of the prostate in a day-surgery setting: general anesthesia with either fentanyl and propofol total IV anesthesia (TIVA) or with fentanyl, thiopental, and isoflurane (F-P-I), versus spinal block using 5 mg of 0.5% large-dose spinal hyperbaric bupivacaine (LDS) or 2.5 mg of 0.5% hyperbaric bupivacaine plus fentanyl 25 µg small-dose spinal (SDS). Operating room time was shorter in the general anesthesia groups. TIVA patients voided earlier (103 ± 41 min) than F-P-I patients (131 ± 65 min), SDS (126 ± 55 min), and LDS patients (169 ± 65 min; P < 0.05 TIVA versus all groups and between spinal groups). TIVA patients were discharged earlier (119 ± 42 min) than F-P-I patients (160 ± 69 min) and SDS or LDS patients (132 ± 53 and 186 ± 72 min, respectively; P < 0.05 versus all groups and between the spinal groups). There were no intergroup differences regarding postanesthesia nausea or vomiting, pain score, return to normal function at home, or overall satisfaction. Whereas all four techniques are suitable for this procedure, TIVA provides the earliest voiding and consequently fastest discharge. Between spinal techniques, the SDS technique requires more intraoperative sedation but provides earlier voiding and consequently earlier discharge. TIVA, general anesthesia with isoflurane and fentanyl, and two spinal techniques (5 mg of bupivacaine 0.5% or 2.5 mg of bupivacaine 0.5% plus 25 µg of fentanyl) are suitable techniques for transperineal brachytherapy in the day-surgery setting. TIVA allows for earliest voiding and therefore fastest discharge home. Spinal block with 2.5 mg of bupivacaine plus 25 µg of fentanyl provides earlier voiding and consequently earlier discharge than 5 mg of bupivacaine alone.