In this paper, we report 250 enucleations for benign prostatic hyperplasia during 10 years from 1967 to 1976. Retropubic and suprapubic methods were performed. In this series of 250 prostatectomies, 100 cases were operated on under general anesthesia (GOF-method), 100 cases under spinal anesthesia and 50 cases under epidural anesthesia. Cases operated under spinal or epidural anesthesia presented a considerably remarkable reduction of the blood loss level as compared with those under general anesthesia.
1) The average blood loss levels were as follows; 303.8g in the spinal group, 310.6g in the epidural and 568.1g in the general. When the two-way classification analysis of variance was used, a significant reduction of the blood loss level was observed between the spinal and the general group (p<0.05) and also between the epidural and the general group (p<0.05). No significant reduction was observed between the spinal and the epidural groups.
2) As to the blood transfusion level in each group during and after the operation, results similar to those of the blood loss level were obtained. Namely the reduction of the blood transfusion level was observed in both the spinal and epidural groups.
3) No significant differences were observed between the two operation methods as to the blood loss and the transfused blood volume.
4) Regarding the behaviors of the lowest systolic blood pressure during the course of the operation under spinal or epidural anesthesia, significant reduction was observed as compared with those under general anesthesia (p<0.05). Accordingly it is considered that the reduction of the blood loss level was contributed by the reduction of the lowest blood pressure.
5) Operating time under spinal or epidural anesthesia was significantly shorter than that under general anesthesia (p<0.05).
6) Correlation was observed among the following factors regardless of anesthesia methods adopted: the blood loss level and the weight of the enucleated prostate gland; the blood loss level and the operating time.
7) The following matters had no influence on hemorrhage in cases prostatectomized under spinal or epidural anesthesia; preoperative blood pressure, preoperative hemoglobin, bleeding time, coagulation time and count of platelet. On the other hand, a significant correlation was observed between the blood loss level and the bleeding time in cases of general antsthesia.
8) Hospital stay and catheter days did not correlate with blood loss level regardless of the adopted anesthetic method.
9) No operative mortality was observed when prostatic enucleation was performed under spinal or epidural anesthesia, but two operative mortalities were observed under general anesthesia.
In this study, both spinal and epidural anesthesia seem to have advantages for prostatic surgery.
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