A Randomized Study of the Efficacy of Low Venous Pressure General Anesthesia Versus Combined Spinal-Epidural Anesthesia in Decreasing Blood Loss During Radical Retropubic Prostatectomy
This is a prospective randomized trial comparing the efficacy of a low venous pressure
general anesthesia (LVPGA) technique vs. combined spinal-epidural anesthesia (CSE) in
decreasing intraoperative blood loss in patients undergoing open radical retropubic
prostatectomy (RRP) for newly diagnosed clinically localized adenocarcinoma of the prostate.
The study design involves the enrollment of 246 patients scheduled for RRP. To control for
surgeon technique in the varibility of intraoperative blood loss, the study will be limited
to the patient population of two surgeons who perform greater than 150 radical
prostatectomies per year. Patients will be stratified for each surgeon and will be
randomized to receive either a LVPGA or CSE. Preoperatively patients will be encouraged to
donate autologous blood as is the current practice at MSKCC. Perioperative measurement and
management of fluid administration, estimation of blood loss and urine output, and
transfusion criteria will be standardized for both anesthesia groups. Transfusion of blood
products will be at the discretion of the attending surgeon and anesthesiologist following
the guidelines described in the protocol. Autologous blood will not routinely be transfused
back if the hemoglobin is >= 8.0 and the patient is not symptomatic. Patients randomized to
the CSE arm will also receive postoperative epidural analgesia, while patients randomized to
LVPGA will receive intravenous PCA analgesia as per our current standard of care. Pain
relief will be assessed by a standardized pain scale and recorded in the PACU and then twice
daily until discharge. All patients will receive routine preoperative evaluation, as well
as routine intraoperative and postoperative monitoring and care. All patients will be placed
on a routine postoperative pathway. The MSKCC Morbidity/Mortality DMT Documentation System
will be utilized to document postoperative complications as per our routine practice. The
Surgical Secondary Events (SSE) program is designed to provide risk adjusted postoperative
morbidity and mortality data for institutional comparisons and as a decision support
project, generating, reporting and analyzing events to promote change and improvement in
patient management. SSE are grouped in 6 grades depending on the severity of the
complication and the treatment requirements: Grade 0, no event observed beyond 30 days
postop. Grade 1, use of oral medications, bedside interventions to treat an event. Grade 2,
use of I.V. medications, TPN, enteral nutrition, or blood transfusion to treat an event.
Grade 3, interventional radiology, therapeutic endoscopy, intubation, angiography or
operation required to treat an event. Grade 4, residual and lasting disability requiring
major rehabilitation or organ resection. Grade 5, event resulting in death of patient.
Interventional
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Single Group Assignment, Masking: Open Label, Primary Purpose: Prevention
Aim #1: To determine whether LVPGA reduces blood loss by >= 300 ml versus CSE in patients undergoing open RRP
Sherri M Donat, MD, FACS
Principal Investigator
Memorial Sloan-Kettering Cancer Center
United States: Food and Drug Administration
05-003
NCT00200187
February 2005
January 2007
Name | Location |
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Memorial Sloan-Kettering Cancer Center | New York, New York 10021 |