The Effects of Method of Anaesthesia on the Safety and Effectiveness of Radical Retropubic Prostatectomy

Summary

Prostate cancer is one of the most commonly diagnosed neoplasm in men worldwide. The gold standard of therapy is radical prostatectomy, a wide surgical excision of the neoplasm and can be performed either open, laparoscopic or robotic. The open retropubic approach, still performed today, can be completed under either general anaesthesia or combined (spinal/epidural) anaesthesia without any clear guideline on which one should be preferred.

In this study the investigators aim to evaluate general anaesthesia and combined (spinal/ epidural) anaesthesia in patients undergoing open retropubic radical prostatectomy and define whether these may have an impact on the oncological outcome and safety of the procedure.

Conditions

• Prostatic Neoplasm

Interventions

PROCEDURE

General Anaesthesia

All patients in the general anaesthesia group will be premedicated with intravenously administered (iv) midazolam (2mg) and fentanyl (100 mcg). Induction will be performed using intravenous propofol (2.5-3mg/kg) and lidocaine (40mg); dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg will also be administered. After successful tracheal intubation, total intravenous anaesthesia will be maintained by administering propofol (0.05 mg/kg/sec iv) and remifentanil (0.2 mcg/kg/sec iv). Pain management will be achieved by paracetamol (1g iv) and tramadol (100mg iv) whereas muscle relaxation by vecuronium (0.6 mg/kg iv).

PROCEDURE

Combined (Epidural and Spinal) Anaesthesia

Combined (epidural and spinal) anaesthesia will be performed using an epidural 18G needle and a spinal 27G needle, in the L2-L3 or L3-L4 interspace. Induction will be carried out by spinal intrathecal administration of levobupivacaine (2.6-3ml of 0.5%) and mild sedation by midazolam (5mg iv in bolus). All patients will be administered dexamethasone 8mg, metoclopramide 10mg and omeprazole 40mg iv. Maintenance will be performed 75 minutes after induction and obtained using an epidural administration of levobupivacaine (4-5ml of 0.5%).

PROCEDURE

Open Retropubic Radical Prostatectomy

All patients will undergo a nerve-sparing open retropubic radical prostatectomy

Sponsors & Collaborators

• National and Kapodistrian University of Athens

  collaborator OTHER

• Sismanoglio General Hospital

  lead OTHER

Principal Investigators

• Konstantinos Pikramenos, MD · 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

• Iraklis Mitsogiannis, Assoc. Prof. · 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

• Ioannis Varkarakis, Prof. · 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

• Athanasios Papatsoris, Prof. · 2nd Urology Department, Sismanoglio Hospital, National and Kapodistrian University of Athens

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Sex

MALE

Healthy Volunteers

No

Timeline & Regulatory

Start

2020-07-27

Primary Completion

2022-08-31

Completion

2022-09-30

Countries

• Greece

Study Locations