Open Access

ARTICLE

Epidural anesthesia can block the negative effects of prostaglandin mediators during prostate surgery

Nebojsa Ladjevic^1,4, Otas Durutovic^2,4, Ivana Likic-Ladjevic⁴, Natasa Lalic³, Ana Mimic¹, Natasa Dencic¹, Svetlana Sreckovic¹, Zoran Dzamic², Milan Terzic⁴, Aleksandar Vuksanovic^2,4, Dragica Milenkovic-Petronic^2,4

1 Department of Anesthesiology, Urology Hospital, Clinical Centre of Serbia, Belgrade, Serbia
2 Urology Hospital, Clinical Centre of Serbia, Belgrade, Serbia
3 Department of Medical Biochemistry, Urology Hospital, Clinical Centre of Serbia, Belgrade, Serbia
4 School of Medicine, University of Belgrade, Belgrade, Serbia
Address correspondence to Dr. Otas Durutovic, Urology Hospital, Clinical Centre of Serbia, Resavska 51 Street, 11000 Belgrade, Serbia

Canadian Journal of Urology 2013, 20(6), 7021-7027.

Abstract

Introduction: Inflammation plays a key role in the development of benign prostatic hyperplasia. Prostaglandin E2 (PGE2) is an important inflammation factor found in enlarged prostatic tissue that can be the main cause of inflammatory pain. The aim of this study was to investigate whether epidural anesthesia can block the negative effects of prostaglandin mediators during prostate surgery.
Materials and methods: The study included 60 patients who underwent open prostatectomy. All patients were randomly allocated to one of two study groups. The first group received general anesthesia and the second group a combination of general and epidural anesthesia. Main outcome measures were plasma concentration of PGE2, adrenaline, noradrenaline, and dopamine, before induction of anesthesia and at the time of enucleation.
Results: Preoperative serum concentrations of PGE2 were high in both groups. During enucleation, serum concentrations of adrenaline, noradrenaline, and dopamine increased, followed by a rise of systolic and diastolic blood pressure in the group of patients that received only general anesthesia. Serum concentration of PGE2 was at the same level as before induction of anesthesia in both groups.
Conclusion: Epidural anesthesia blocks transmission of painful stimulus through the spinal cord caused by prostaglandin release and prevents the rise of catecholamines and blood pressure. Open prostatectomy can become a safer procedure performed under a combination of general and epidural anesthesia. Negative intraoperative effects of inflammatory prostate mediators during other techniques for prostate surgery could also be blocked with epidural anesthesia.

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