Spinal anesthesia as an adjunct to general anesthesia for robotic assisted laparoscopic prostatectomy – a randomised placebo-controlled trial

Background Novel surgical techniques have facilitated faster recoveries after radical laparoscopic prostatectomy, yet abdominal pain and urinary catheter related discomfort remain a clinical challenge. We hypothesised that spinal anesthesia as an adjunct to general anesthesia would facilitate faster recovery and less postoperative pain and discomfort compared to standard medical treatment. Methods A double-blind randomised study was designed with one group (n = 15) allocated to general anesthesia and intrathecal injection of hyperbaric bupivacaine (7.5 mg)/spinal morphine (100 µg), while controls (n = 15) received general anesthesia and a sham spinal procedure before they underwent robotic prostatectomy. Two hours before induction of anesthesia, all patients received orally paracetamol 1 g, dexamethasone 8 mg and etoricoxib 90 mg. General anesthesia was performed using remifentanil, propofol and rocuronium. Postoperative analgesia consisted of intravenous morphine via a patient-controlled device, oral etoricoxib 90 mg x 1 and paracetamol 1 gr x 4. Primary outcome measure was time to discharge from the post anesthesia care unit (PACU). Secondary outcome measures were postoperative pain and opioid consumption. Results Patients who received spinal anesthesia were discharged earlier from the PACU (p = 0.010) and reported less pain on admittance to the PACU and after 2 hrs (p = 0.019 and p < 0.001, respectively). Furthermore, peak pain score (p = 0.007) and opioid consumption (p = 0.04) were lower in the spinal group during the PACU stay. Patients who received spinal anesthesia reported less discomfort related to bladder spasm (p = 0.021) and urgency (p < 0.001). Quality of recovery-15 score was higher in the spinal group (p < 0.001). No attributable side effects related to spinal anesthesia and intrathecal morphine were observed. Conclusions Spinal anesthesia as an adjunct to general anesthesia facilitated faster recovery, better pain relief and less discomfort compared to standard medical treatment after robotic assisted laparoscopic prostatectomy. Patients in the spinal group were more satisfied as assessed by QoR-15.