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Process optimisation: spinal versus general anaesthesia for endourological surgery. A randomised, controlled trial
Kornel Skitek1, Gregor A Schittek2, Jens Soukup3
1Department of Anaesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
Anaesthesiology Intensive Therapy
|February 7, 2025
Summary
Total intravenous anaesthesia (TIVA) resulted in the quickest ambulation time for endourology patients. Spinal anaesthesia (SPA) with prilocaine offered the best balance for optimal anesthesia, minimizing hypotension risks.
Area of Science:
- Anesthesiology
- Urology
- Surgical Procedures
Background:
- Anesthesia options for endourology are numerous, making optimal regimen selection challenging.
- Limited data exists on anesthesia efficacy for endourological procedures.
Purpose of the Study:
- To compare spinal anaesthesia (SPA) with total intravenous anaesthesia (TIVA) for endourology.
- To identify the optimal anesthesia approach for endourological procedures.
Main Methods:
- A randomized, open-label, controlled study involving 117 patients.
- Three groups: SPA with bupivacaine (G1), SPA with prilocaine (G2), and TIVA with remifentanil/propofol (G3).
- Primary outcome: time to ambulation; Secondary outcome: perioperative hypotension.
Main Results:
- Time to ambulation was shortest with TIVA (129.14 min), followed by SPA with prilocaine (161.05 min) and SPA with bupivacaine (187.95 min).
- Perioperative hypotension was most pronounced with TIVA (35% drop) and least with SPA/prilocaine (18% drop).
- Machine learning models effectively predicted recovery time.
Conclusions:
- Total intravenous anaesthesia (TIVA) offers the fastest ambulation post-endourology.
- Spinal anaesthesia (SPA) with prilocaine provides a near-optimal balance, minimizing hypotension.
- Anesthesia choice impacts recovery time and hemodynamic stability in endourology.
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