Epidural Anesthesia for Transurethral Resection of The Prostate

NCT ID: NCT06893809

Last Updated: 2025-07-25

Study Results

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Basic Information

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Recruitment Status

COMPLETED

Clinical Phase

NA

Total Enrollment

60 participants

Study Classification

INTERVENTIONAL

Study Start Date

2010-01-02

Study Completion Date

2010-12-30

Brief Summary

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The aim of this study is to assess the effects of different routes of local anesthetic administration in epidural anesthesia applied to patients undergoing transurethral resection of the prostate (TUR-P). ASA I-III 60 patients were enrolled in the study. Patients were randomized into the following three groups: in Group N (needle), total dose of local anesthetic was administered through the Tuohy needle (n=20), in Group C (catheter), local anesthetic was administered through the epidural catheter (n=20) and in Group N/C (needle/catheter), local anestetic was administered half volume through the needle and half through the catheter (n=20). Hemodynamics, times to reach sensory block T10 (block levels), side effects, patient and surgeon satisfaction were evaluated.

Detailed Description

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In urological procedures, the preferred anaesthetic modalities may be topical, regional or general. The decision is made by the anaesthesiologists based on patient age, sex, general condition and the surgical procedure to be performed. Transurethral procedures are frequently applied to geriatric patients, who are more likely to have comorbidities. In such cases, epidural anaesthesia may be preferred for geriatric patients.

In this study, we utilised various routes for the administration of local anaesthetics to induce epidural anaesthesia in patients scheduled for transurethral resection of the prostate (TUR-P) due to benign prostatic hyperplasia. The study encompassed the evaluation of haemodynamic stability, the time to reach sensory block T10, the occurrence of side effects, and the levels of patient and surgeon satisfaction.

Following the approval of the hospital ethics committee, 60 male patients aged 40-75, ASA class I-III, scheduled for elective TUR-P surgery were enrolled in the study.According to the method of local anaesthetic administration, patients were randomly divided into three groups:

Group N (needle); total local anaesthetic administered through the Tuohy needle,Group C (catheter); local anaesthetic administered through the epidural catheter,Group NC (needle/catheter); 50% of local anaesthetic administered through the needle and 50% through the catheter.Patients underwent standard monitorisation in the operating theatre. Each patient received 0.03 mg/kg of midazolam intravenously following catheterisation with a 20-gauge intravenous cannula.Prior to the commencement of epidural block, patients were preloaded with 10 ml/kg of 0.9% isotonic saline infused over a 30-minute period. The hemodynamic parameters were then recorded before and after the premedication, following the epidural block, and every 5 minutes until the patient's sensory block level regressed to L1 dermatome.The epidural anaesthesia was then attempted with an 18-gauge Tuohy needle at the L3-4 interspinal level using the loss of resistance technique following infiltration with 2% lidocaine. Patients in Group N received a mixture of 8ml 2% prilocaine, 7ml 0.5% levobupivacaine and 50μg fentanyl through the epidural space using a Tuohy needle. Patients in Group C received the same drug combination through the epidural catheter. Patients in Group NC received half of the same drug combination through the needle and half through the epidural catheter. Patients were positioned in the right lateral decubitus position with thighs flexed up and neck flexed forward (fetal position), and then placed supine following drug administration.In all groups, time "0" was considered as the time that drug administration was started.

The sensory and motor block levels, heart rates and mean arterial blood pressure values, times to reach sensory block level T10, and side effects were recorded for all patients. Patient and surgeon satisfaction levels were evaluated using a 3-point satisfaction scale by an observer unaware of the study's objectives.Surgeon satisfaction was evaluated during the operation, and patient satisfaction was assessed in the recovery room before patients were transferred to their service bed.

Post-operatively, patients were admitted to the recovery room, the epidural catheter was removed following regression of sensory block to T10 dermatome, and patients were transferred to the service.

Conditions

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Epidural Catheter Epidural Analgesia Geriatric Cardiology Urologic Disorders Hemodynamic (MAP) Stability Pain Management

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Group N

Group N (Needle)

Group Type ACTIVE_COMPARATOR

Epidural injection via catheter

Intervention Type PROCEDURE

Local anesthetic was administered entirely through the epidural catheter.

Combined epidural injection (needle and catheter)

Intervention Type PROCEDURE

Half of the total local anesthetic dose was administered through the needle and half through the catheter.

Group C

Group C (Catheter)

Group Type ACTIVE_COMPARATOR

Epidural injection via Tuohy needle

Intervention Type PROCEDURE

Local anesthetic was administered entirely through the Tuohy needle.

Combined epidural injection (needle and catheter)

Intervention Type PROCEDURE

Half of the total local anesthetic dose was administered through the needle and half through the catheter.

Group N/C

Group N/C (Needle/Catheter)

Group Type ACTIVE_COMPARATOR

Epidural injection via Tuohy needle

Intervention Type PROCEDURE

Local anesthetic was administered entirely through the Tuohy needle.

Epidural injection via catheter

Intervention Type PROCEDURE

Local anesthetic was administered entirely through the epidural catheter.

Interventions

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Epidural injection via Tuohy needle

Local anesthetic was administered entirely through the Tuohy needle.

Intervention Type PROCEDURE

Epidural injection via catheter

Local anesthetic was administered entirely through the epidural catheter.

Intervention Type PROCEDURE

Combined epidural injection (needle and catheter)

Half of the total local anesthetic dose was administered through the needle and half through the catheter.

Intervention Type PROCEDURE

Other Intervention Names

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Epidural anesthesia - needle route Epidural anesthesia - catheter route Epidural anesthesia - combined route

Eligibility Criteria

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Inclusion Criteria

* Male undergoing transurethral prostatic resection,
* 40 to 75 years old,
* ASA-I-III
* Not using anticoagulants or antiaggregants,
* No peripheral neuropathy or muscle disease,
* Can be orientated and co-operated,
* No vertebral deformity,
* Body Mass Index \<30,
* Patients consenting to epidural anaesthesia.

Exclusion Criteria

* TUR-P operation will not be male,
* Female patients,
* ASA-IV,
* Not in the appropriate age range (40-75),
* Taking anticoagulants or antiaggregants, Previous lumbar surgery or skeletal deformity in the lumbar region,
* Peripheral neuropathy, neuromuscular or neuropsychiatric disease,
* Alcohol or drug addiction,
* Obese with a body mass index \>30,
* History of frequent analgesic use,
* Patients shorter than 155 cm and taller than 180 cm,
* Who refused epidural anaesthesia,
* Patients without orientation and co-operation.
Minimum Eligible Age

40 Years

Maximum Eligible Age

75 Years

Eligible Sex

MALE

Accepts Healthy Volunteers

No

Sponsors

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Ankara City Hospital Bilkent

OTHER

Sponsor Role collaborator

Başakşehir Çam & Sakura City Hospital

OTHER_GOV

Sponsor Role lead

Responsible Party

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Emine OZCAN

Principal Investigator

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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NERMİN GÖĞÜŞ, Prof.Dr.

Role: STUDY_CHAIR

Ankara City Hospital Bilkent

Locations

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Ankara Numune Education and Research Hospital

Ankara, Altındağ, Turkey (Türkiye)

Site Status

Countries

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Turkey (Türkiye)

References

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Barbosa FT, Castro AA. Neuraxial anesthesia versus general anesthesia for urological surgery: systematic review. Sao Paulo Med J. 2013;131(3):179-86. doi: 10.1590/1516-3180.2013.1313535.

Reference Type BACKGROUND
PMID: 23903267 (View on PubMed)

Kim JH, Lee JS, Kim DY. Direction of catheter insertion and the incidence of paresthesia during continuous epidural anesthesia in the elderly patients. Korean J Anesthesiol. 2013 May;64(5):443-7. doi: 10.4097/kjae.2013.64.5.443. Epub 2013 May 24.

Reference Type BACKGROUND
PMID: 23741568 (View on PubMed)

Horlocker TT, Abel MD, Messick JM Jr, Schroeder DR. Small risk of serious neurologic complications related to lumbar epidural catheter placement in anesthetized patients. Anesth Analg. 2003 Jun;96(6):1547-1552. doi: 10.1213/01.ANE.0000057600.31380.75.

Reference Type BACKGROUND
PMID: 12760972 (View on PubMed)

Yun MJ, Kim YC, Lim YJ, Choi GH, Ha M, Lee JY, Ham BM. The differential flow of epidural local anaesthetic via needle or catheter: a prospective randomized double-blind study. Anaesth Intensive Care. 2004 Jun;32(3):377-82. doi: 10.1177/0310057X0403200313.

Reference Type BACKGROUND
PMID: 15264734 (View on PubMed)

Omote K, Namiki A, Iwasaki H. Epidural administration and analgesic spread: comparison of injection with catheters and needles. J Anesth. 1992 Jul;6(3):289-93. doi: 10.1007/s0054020060289.

Reference Type BACKGROUND
PMID: 15278539 (View on PubMed)

Crochetiere CT, Trepanier CA, Cote JJ. Epidural anaesthesia for caesarean section: comparison of two injection techniques. Can J Anaesth. 1989 Mar;36(2):133-6. doi: 10.1007/BF03011434.

Reference Type BACKGROUND
PMID: 2650896 (View on PubMed)

Visser WA, Lee RA, Gielen MJ. Factors affecting the distribution of neural blockade by local anesthetics in epidural anesthesia and a comparison of lumbar versus thoracic epidural anesthesia. Anesth Analg. 2008 Aug;107(2):708-21. doi: 10.1213/ane.0b013e31817e7065.

Reference Type BACKGROUND
PMID: 18633056 (View on PubMed)

Cesur M, Alici HA, Erdem AF, Silbir F, Yuksek MS. Administration of local anesthetic through the epidural needle before catheter insertion improves the quality of anesthesia and reduces catheter-related complications. Anesth Analg. 2005 Nov;101(5):1501-1505. doi: 10.1213/01.ANE.0000181005.50958.1E.

Reference Type BACKGROUND
PMID: 16244020 (View on PubMed)

Ulker B, Erbay RH, Serin S, Sungurtekin H. Comparison of spinal, low-dose spinal and epidural anesthesia with ropivacaine plus fentanyl for transurethral surgical procedures. Kaohsiung J Med Sci. 2010 Apr;26(4):167-74. doi: 10.1016/S1607-551X(10)70025-5.

Reference Type BACKGROUND
PMID: 20434097 (View on PubMed)

Sorenson RM, Pace NL. Anesthetic techniques during surgical repair of femoral neck fractures. A meta-analysis. Anesthesiology. 1992 Dec;77(6):1095-104. doi: 10.1097/00000542-199212000-00009.

Reference Type BACKGROUND
PMID: 1466461 (View on PubMed)

Bernstein S, Malhotra V. Regional anesthesia for genitourinary surgery. In Malhotra V (ed): Anesthesia for Renal And Genitourinary

Reference Type BACKGROUND

Blake DW. The general versus regional anaesthesia debate: time to re-examine the goals. Aust N Z J Surg. 1995 Jan;65(1):51-6. doi: 10.1111/j.1445-2197.1995.tb01748.x.

Reference Type BACKGROUND
PMID: 7818424 (View on PubMed)

Morgan GE, Mikhail MS, Murray MJ, Larson CP. Regional Anesthesia &Pain Management, Clinical Anesthesiology. 3rd edition. Los Angeles:

Reference Type BACKGROUND

Tsui BC, Wagner A, Finucane B. Regional anaesthesia in the elderly: a clinical guide. Drugs Aging. 2004;21(14):895-910. doi: 10.2165/00002512-200421140-00001.

Reference Type BACKGROUND
PMID: 15554749 (View on PubMed)

Provided Documents

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Document Type: Statistical Analysis Plan

View Document

Study Documents

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Document Type: Clinical Study Report

Int J Clin Anesthesiol 4(1): 1050 (2016)

View Document

Related Links

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Other Identifiers

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Corresponding Author

Identifier Type: OTHER

Identifier Source: secondary_id

ANEAH2010

Identifier Type: -

Identifier Source: org_study_id

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