Introduction and Objectives
The majority of published reports investigate the results of general and epidural anaesthesia separately. Several papers compare the effect of these methods in terms of peri- and post-operative morbidity (blood loss, sideeffects and possible complications). To our knowledge this is one of the few attempts of comparing the 2 methods by recording the patient's pain perception and tolerance of the transurethral procedures.
Material and Methods
The study comprised 97 and 47 patients who underwent transurethral bladder tumour resection (TUR-B) and prostatectomy (TUR-P), respectively. Post-operative pain severity was recorded using an 11-point visual analogue scale (VAS). Pain scoring was stratified by age, gender, tumour stage and grade. Clinical and demographical characteristics were compared using the Mann-Whitney U test for continues variables and the chi-square test for categorical variables. Odds ratios were used to quantify the strength of association between variables. Kruskal-Wallis test was used to estimate equality of population medians among groups and the Mann-Whitney U test for comparison between the groups. The Spearman correlation coefficient (when appropriate) was used to examine the independence between categorical variables.
VAS score was greatest at discharge from recovery room (time 0 h) for general anaesthesia vs epidural [1.5(0–8) vs 0 (0–8) (p = 0.027)]. The pattern changes significantly at 8 h and 12 h for general anaesthesia's analgesic efficacy compared to epidural [1.02 (0–6) vs 2.05(0–6) and 1.62 (0–7) vs 0.2 (0–8) (p = 0.017 and p = 0.007 respectively]. A higher VAS score was observed from 0 h to 24 h for pT2 patients. Patients with resected tumour volume >10 cm3 presented VAS score >3 at 8 h and 24 h (p = 0.050, p = 0.036, respectively).
It seems that epidural anaesthesia is more effective during the first 2 post-operative hours, while general prevails at later stages and at larger traumatic surfaces. Finally, we incidentally found that tumour stage plays a significant role in post-operative pain, a point that requires further verification.
© 2009 European Association of Urology. Published by Elsevier Inc. All rights reserved.