| The effect of local compression and topical epinephrine on perioperative bleeding and degree of urinary extravasation on postoperative cystogram following radical retropubic prostatectomy. | |
| | |
MedLine Citation:
|
PMID: 20735906 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVE: To evaluate the efficacy of local compression and topical epinephrine in controlling perioperative bleeding during open radical retropubic prostatectomy (ORRP) and its impact on the degree of urinary extravasation on initial postoperative cystogram. METHODS: Between September 2005 to March 2009, 476 men underwent ORRP performed by a single surgeon. Group 1 (n = 200) underwent ORRP between September 2005 and November 2006 without pelvic compression; Group 2 (n = 76) underwent ORRP between November 2006 and May 2007 and a dry laparotomy pad was positioned in the pelvis immediately prior to abdominal wound closure; Group 3 (n = 200) underwent ORRP between May 2007 and March 2009 with a epinephrine soaked laparotomy pad positioned in the pelvis prior to abdominal wound closure. Hematocrit values were obtained prior to anesthesia induction, upon arrival in the recovery room and at hospital discharge in order to estimate intraoperative and postoperative bleeding. The number of allogenic and autologous units transfused was recorded. The utility of compressing the pelvis with a pad was examined by comparing estimated postoperative bleeding between Group 1 versus Groups 2 and 3 and the hemostatic utility of soaking the pad in epinephrine was examined by comparing Group 2 versus 3. Systolic and diastolic blood pressure and pulse measurements were obtained at baseline and 5 and 10 minutes after introducing the epinephrine pad. The relationship between estimated blood loss and degree of extravasation on initial postoperative cystogram was investigated. RESULTS: Estimated intraoperative, postoperative and total blood loss (mean change in Hct) was 12.2, 2.3, 14.2, in Group 1, 10.0, 1.5, 11.1 in Group 2, and 10.8, 2.1, and 12.6 in Group 3. Estimated intraoperative and total blood loss was significantly less in the men treated with a compression pad (Groups 2 and 3) versus no pad (Group 1). There were no significant differences in number of patients transfused, the number of units transfused or the degree of extravasation on postoperative cystograms between Group 1 versus Group 2 and 3 or Group 2 versus 3. However, postoperative bleeding was significantly less in Group 2 compared to Group 3. Mean systolic and diastolic blood pressure and pulse values were unchanged from baseline after epinephrine use. CONCLUSIONS: Local compression of the pelvis with or without epinephrine prior to abdominal wound closure does not appear to have beneficial effects on reducing postoperative bleeding and decreasing the degree of urinary extravasation on cystogram following ORRP. While the use of topical epinephrine appears to be safe and relatively inexpensive, at the concentrations used in our study it does not appear to facilitate postoperative hemostasis. |
| | |
Authors:
|
Rena Malik; Juliana Laze; Herbert Lepor |
Related Documents
:
|
19882376 - Evolution of recombinant factor viii safety: kogenate and kogenate fs/bayer. 17357836 - Capsule endoscopy changes patient management in routine clinical practice. 10235606 - Natural history of late radiation proctosigmoiditis treated with topical sucralfate sus... 15943856 - Comparison of hemostatic effects by route of h2 receptor antagonist administration foll... 12770246 - Tolerance of pupae and pharate adults of callosobruchus subinnotatus pic (coleoptera: b... 9773696 - The paravertebral nerve root block for inguinal herniorrhaphy--a comparison with the fi... |
Publication Detail:
|
Type: Journal Article |
Journal Detail:
|
Title: The Canadian journal of urology Volume: 17 ISSN: 1195-9479 ISO Abbreviation: Can J Urol Publication Date: 2010 Aug |
Date Detail:
|
Created Date: 2010-08-25 Completed Date: 2010-11-22 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 9515842 Medline TA: Can J Urol Country: Canada |
Other Details:
|
Languages: eng Pagination: 5272-7 Citation Subset: IM |
Affiliation:
|
Department of Urology, New York University, New York, New York 10016, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Administration, Topical Epinephrine / administration & dosage* Humans Male Middle Aged Musculoskeletal Manipulations Postoperative Complications / etiology, prevention & control Postoperative Hemorrhage / prevention & control* Pressure Prostatectomy* Retrospective Studies Urine Vasoconstrictor Agents / administration & dosage* |
| Chemical | |
Reg. No./Substance:
|
0/Vasoconstrictor Agents; 51-43-4/Epinephrine |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: Analysis of testosterone suppression in men receiving histrelin, a novel GnRH agonist for the treatm...
Next Document: Lower urinary tract leiomyoma: is excision necessary?