Transüretral prostat rezeksiyonu olan yaşlı hastalarda genel ve rejyonal anestezi uygulamalarının ameliyat sonrası yaşam kalitesine etkilerinin karşılaştırılması

Year 2022, Volume: 13 Issue: 47, 316 - 322, 15.12.2022

Sedef Gülçin Ural , Fatih Gokalp , Sinan Karazindiyanğlu , İbrahim Hakkı Tör

https://doi.org/10.17944/mkutfd.1025384

Abstract

Amaç: Çalışmamızda benign prostat hipertrofisi nedeniyle alt üriner sistem semptomları olan ve transüretral prostat rezeksiyonu uygulanacak hastalara uygulanan anestezi yönteminin postoperatif yaşam kalitesi üzerinde etkisinin olup olmadığı araştırıldı.

Yöntem: Çalışmaya transüretral prostat rezeksiyonu planlanan 60 hasta dahil edildi. 1. gruba spinal anestezi, 2. gruba genel anestezi uygulandı. Demografik veriler, preoperatif ve perioperatif parametreler kaydedildi. Postoperatif yaşam kalitesi ve hasta memnuniyeti Kısa form-36 (SF-36) kullanılarak değerlendirildi.

Bulgular: Demografik veriler ve hemodinamik değişiklikler açısından gruplar arasında fark yoktu. Alkol ve sigara kullananların sigara içmeyenlere göre genel anestezi tercihi daha yüksekti (p<0.05). Hastaların perioperatifhemodinamik bulguları her iki grupta benzerdi (p>0,005). Spinal anestezi grubunda preoperatif ve postoperatif SF-36 alt alan skorları karşılaştırıldığında, tüm parametrelerde istatistiksel olarak anlamlı fark vardı (p<0,001). Ameliyat öncesi ve sonrası SF 36 alt alan skorları genel anestezi grubu içinde karşılaştırıldığında, vitalite, mental sağlık ve sosyal işlevsellik açısından istatistiksel olarak anlamlı farklılıklar gözlendi (p<0.05). Spinal ve genel anestezi grubunun ameliyat öncesi SF-36 alt alan puanları arasında istatistiksel olarak anlamlı fark yoktu (p>0.05). Spinal anestezi grubunda postoperatif birinci ay skorları genel anestezi grubuna göre vitalite skorları dışında alt alanlarda istatistiksel olarak anlamlı derecede yüksekti (p<0.05).

Sonuç: Geriatrik hasta popülasyonunda yapılan TUR-P ameliyatında anestezi sonrası erken yaşama katılmanın önemi yüksektir. Çalışmamız, hasta yaşam kalitesi ve hasta memnuniyeti açısından spinal anestezinin genel anesteziden üstün olduğunu destekledi.

Keywords

anestezi, prostat, yaşam kalitesi, transüretral rezeksiyon

Comparison of the effects of general and regional anesthesia on postoperative quality of life in elderly patients after transurethral prostate resection

Abstract

Objective: In our study, it was investigated whether the anesthesia method applied to patients with lower urinary tract symptoms due to benign prostatic hypertrophy and who will undergo transurethral resection of the prostate has effects on postoperative quality of life.

Method: A total of 60 patients scheduled for TUR-P were included in the study. The patients were divided into two groups as those receiving spinal anesthesia and those receiving general anesthesia. We recorded demographic data and preoperative and perioperative parameters. We evaluated the postoperative quality of life and satisfaction of the patients using the Short Form-36 scale.

Results: There was no statistically significant difference between the two groups in terms of demographic data and hemodynamic changes. There was a higher rate of patients who consumed alcohol and smoked in the general anesthesia group (p<0.05). The perioperative hemodynamic findings of the patients were similar in both groups (p>0.05). The preoperative and postoperative SF-36 subdomain scores were compared within the spinal anesthesia group, there was a statistically significant difference in all parameters (p<0.001). The preoperative and postoperative SF-36 subdomain scores were compared within the general anesthesia group, statistically significant differences were observed in vitality, mental health, and social functioning (p<0.05). There was no statistically significant difference between the preoperative SF-36 subdomain scores of the spinal and general anesthesia group (p>0.05). In the spinal anesthesia group, the postoperative first month scores were statistically significantly higher in the sub-areas, except for the vitality scores, compared to the general anesthesia group (p<0.05).

Conclusion: It is important to ensure that geriatric patients return to their daily life activities in the early period after TUR-P. According to our results, spinal anesthesia was found to be superior to general anesthesia in terms of the quality of life of the patients.

Keywords

anesthesia, prostate, quality of life, transurethral resection

References

• Verhamme KM, Dieleman JP, Bleumink GS, van der Lei J, Sturkenboom MC, Artibani W, et al. Incidence and prevalence of lower urinary tract symptoms suggestive of benign prostatic hyperplasia in primary care--the Triumph project. European urology. 2002;42(4):323-8. Epub 2002/10/04. https://doi.org/10.1016/s0302-2838(02)00354-8.
• Lin Y-H, Chen S-M, Chang P-L, Chen C-L, Tsui K-H. The outcome of a photoselective vaporization prostatectomy using a high performance system to treat benign prostatic hyperplasia with acute urinary retention. Urological Science. 2011;22(4):151-3. https://doi.org/10.1016/j.urols.2011.06.002.
• Stewart AL, Hays RD, Ware JE, Jr. The MOS short-form general health survey. Reliability and validity in a patient population. Medical care. 1988;26(7):724-35. Epub 1988/07/01. https://doi.org/10.1097/00005650-198807000-00007.
• Hepaguslar H, Elar Z. Geriyatrik olgularda genel veya rejyonel anestezi seçimi. Türkiye Klinikleri J Anest Reanim. 2003;1:41-5.
• Kavlak Y. Huzurevinde kalan bireylerin demografik özelliklerinin günlük yaşam aktiviteleri, yaşam kalitesi ve depresyon üzerine etkisi. Akad Geriatri. 2012;4:97-103.
• Ware JE, Jr., Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Medical care. 1992;30(6):473-83. Epub 1992/06/11.
• Kocyigit H. Kisa Form-36 (KF-36)’nm Turkce versiyonunun guvenilirligi ve gecerliligi. Ilac ve Tedavi Dergisi. 1999;12:102-6.
• Malhotra V. Transurethral resection of the prostate. Anesthesiol Clin North Am. 2000;18(4):883-97, x. Epub 2000/11/30. https://doi.org/10.1016/s0889-8537(05)70200-5.
• Djavan B. Lower urinary tract symptoms/benign prostatic hyperplasia: fast control of the patient’s quality of life. Urology. 2003;62(3 Suppl 1):6-14. Epub 2003/09/06. https://doi.org/10.1016/s0090-4295(03)00589-2.
• Zoylan G, Oba S, Çınar SÖ, Paksoy I, Ekşioğlu B, Yılmaz L. Effects of spinal and General Anesthesia on hemodynamic and biochemical changes during Transurethral Rejection operations. The Medical Bulletin of Sisli Etfal Hospital.35(4):43-9.
• Mıngır T, Ervatan Z, Turgut N. Spinal Anestezi ve Perioperatif Anksiyete. Turkish Journal of Anesthesia & Reanimation. 2014;42(4).
• Bugge K, Bertelsen F, Bendtsen A. Patients’ desire for information about anaesthesia: Danish attitudes. Acta Anaesthesiol Scand. 1998;42(1):91-6. Epub 1998/04/04. https://doi.org/10.1111/j.1399-6576.1998.tb05086.x.
• Jlala HA, French JL, Foxall GL, Hardman JG, Bedforth NM. Effect of preoperative multimedia information on perioperative anxiety in patients undergoing procedures under regional anaesthesia. British journal of anaesthesia. 2010;104(3):369-74. Epub 2010/02/04. https://doi.org/10.1093/bja/aeq002.
• Caumo W, Schmidt AP, Schneider CN, Bergmann J, Iwamoto CW, Adamatti LC, et al. Risk factors for postoperative anxiety in adults. Anaesthesia. 2001;56(8):720-8. Epub 2001/08/09. https://doi.org/10.1046/j.1365-2044.2001.01842.x.
• Kettner SC, Willschke H, Marhofer P. Does regional anaesthesia really improve outcome? British journal of anaesthesia. 2011;107 Suppl 1:i90-5. Epub 2011/12/22. https://doi.org/10.1093/bja/aer340.
• Mauermann WJ, Shilling AM, Zuo Z. A comparison of neuraxial block versus general anesthesia for elective total hip replacement: a meta-analysis. Anesth Analg. 2006;103(4):1018-25. Epub 2006/09/27. https://doi.org/10.1213/01.ane.0000237267.75543.59.
• Luger TJ, Kammerlander C, Gosch M, Luger MF, Kammerlander Knauer U, Roth T, et al. Neuroaxial versus general anaesthesia in geriatric patients for hip fracture surgery: does it matter? Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. 2010;21(Suppl 4):S555-72. Epub 2010/11/26. https://doi.org/10.1007/s00198-010-1399-7.
• Burney RE, Prabhu MA, Greenfield ML, Shanks A, O’Reilly M. Comparison of spinal vs general anesthesia via laryngeal mask airway in inguinal hernia repair. Archives of surgery (Chicago, Ill : 1960). 2004;139(2):183-7. Epub 2004/02/11. https://doi.org/10.1001/archsurg.139.2.183.
• Büker N, Koç S, Tuncay ÖL, Şavkın R, Zümrütbaş AE. Transüretral prostat rezeksiyonu sonrasında erken dönem yaşam kalitesindeki değişiklikler. J Kartal TR. 2014;25(3):220-4.
• Le Bars D, Adam F. [Nociceptors and mediators in acute inflammatory pain]. Annales francaises d’anesthesie et de reanimation. 2002;21(4):315-35. Epub 2002/05/30. https://doi.org/10.1016/s0750-7658(02)00592-0.
• Watkins LR, Maier SF, Goehler LE. Immune activation: the role of pro-inflammatory cytokines in inflammation, illness responses and pathological pain states. Pain. 1995;63(3):289-302. Epub 1995/12/01. https://doi.org/10.1016/0304-3959(95)00186-7.
• Watkins LR, Wiertelak EP, Goehler LE, Smith KP, Martin D, Maier SF. Characterization of cytokine-induced hyperalgesia. Brain Res. 1994;654(1):15-26. Epub 1994/08/15. https://doi.org/10.1016/0006-8993(94)91566-0.
• Lee A, Chui PT, Gin T. Educating patients about anesthesia: a systematic review of randomized controlled trials of media-based interventions. Anesth Analg. 2003;96(5):1424-31. Epub 2003/04/23. https://doi.org/10.1213/01.ane.0000055806.93400.93.
• Shevde K, Panagopoulos G. A survey of 800 patients’ knowledge, attitudes, and concerns regarding anesthesia. Anesth Analg. 1991;73(2):190-8. Epub 1991/08/01. https://doi.org/10.1213/00000539-199108000-00013.
• Ramsay MA. A survey of pre-operative fear. Anaesthesia. 1972;27(4):396-402. Epub 1972/10/01. https://doi.org/10.1111/j.1365-2044.1972.tb08244.x.
• Aykent R, Kocamanoğlu İ, Üstün E, Tür A, Şahinoğlu H. Preoperatif anksiyete nedenleri ve değerlendirilmesi: APAIS ve STAI skorlarının karşılaştırılması. Turkiye Klinikleri J Anest Reanim. 2007;5(1):7-13.
• Akildiz M, Aksoy Y, Kaydu A, Kaçar CK, Şahin ÖF, Yıldırım ZB. Effect of anaesthesia method on preoperative anxiety level in elective caesarean section surgeries. Turkish Journal of Anaesthesiology and Reanimation. 2017;45(1):36.
• Matthey P, Finucane BT, Finegan BA. The attitude of the general public towards preoperative assessment and risks associated with general anesthesia. Canadian journal of anaesthesia = Journal canadien d’anesthesie. 2001;48(4):333-9. Epub 2001/05/08. https://doi.org/10.1007/bf03014959.
• Matthey PW, Finegan BA, Finucane BT. The public’s fears about and perceptions of regional anesthesia. Regional anesthesia and pain medicine. 2004;29(2):96-101. Epub 2004/03/19. https://doi.org/10.1016/j.rapm.2003.10.017.
• Lee A, Gin T. Educating patients about anaesthesia: effect of various modes on patients’ knowledge, anxiety and satisfaction. Current opinion in anaesthesiology. 2005;18(2):205-8. Epub 2006/03/15. https://doi.org/10.1097/01.aco.0000162842.09710.d5.