COMPARISON OF PERIOPERATIVE CHANGES IN HEMOSTATIC POTENTIAL WITH LOW-FREQUENCY PIEZOELECTRIC THROMBOELASTOGRAPHY (LPTEG) IN PATIENTS WITH BENIGN PROSTATIC HYPERPLASIA DURING RADICAL RETROPUBIC PROSTATECTOMY
DOI:
https://doi.org/10.31379/2411.2616.15.1.3Keywords:
benign prostatic hyperplasia, surgery, radical retropubic prostatectomy, anesthesia, epidural anesthesia, LPTEG.Abstract
Objectives. To compare perioperative changes in LPTEG of patients undergoing open radical retropubic prostatectomy (ORRP) surgery for benign prostatic hyperplasia (BPH), under general or epidural anesthesia. Materials and methods. The data of patients (n = 69) diagnosed with BPH (confirmed histologically and by PSA level), who underwent surgery for ORRP in the period from November 2017 to November 2019 at the Odessa Regional Clinical Hospital, were prospectively evaluated. Patients were divided into two groups: group A (n = 33) consisted of patients undergoing ORRP using epidural anesthesia (EDA) through a catheter; group B (n = 36) - ORRP using general anesthesia and intravenous opioid analgesia. All participants were tested for hemostatic potential using LPTEG upon admission to the hospital prior to any therapy, immediately before surgery, and at 60 minutes of surgery. Statistical processing of the obtained data was performed using MATLAB software. Results. The baseline data before surgery in patients in both groups demonstrated a compensated hypercoagulable state and coincided with those at the time of admission. However, data at 60 minutes in Group A show a thromboelastogram that is identical to normal; Group B clearly reflects aggregation disorders with normal coagulation and fibrinolysis. The differences were statistically significant (P <0.0001). Conclusion. In compensated hypercoagulative disorder, which is registered in patients with BPH who require ORRP, during surgery with EDA through the catheter, the values of LPTEG are identical to the norm. At the same time, the LTPEG data for ORRP using general anesthesia and intravenous opioid analgesia show a hypoaggregative state with normal hemocoagulation and fibrinolysis rates. The reasons for the above may be the favorable effect of epidural anesthesia on the sympathetic nervous system, as well as reducing the need for the introduction of infusion solutions for EDA due to a comparatively lower level of the blood loss. However, further studies are needed among urological patients to confirm these results and to interpret them for the entire cohort of urological patients.
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