Background and aims Recurrent cancer and metastases depend on the perioperative immune competence which is impaired by surgery, anaesthesia and opiates. Continuous spinal anesthesia (CSA) attenuates the surgical stress response and decreases anesthetic requirements, affording rapid rehabilitation and good early and late outcome.
Methods 45 ASA I-IV patients, age ranged from 36 to 81 years, underwent abdominal surgery for cancer (gastrectomy, colectomy radical prostatectomy, hysterectomy, cystoprostatectomy) by laparotomy or laparoscopy under CSA. Puncture at L2-L3, in the latera decubitus. A 23-gauge spinal catheter over a 27-gauge pencil point needle (Wiley Spinal) was introduced 3 cm intratechally.
First dose : Bupivacaine 20 mg (15 mg = 3 ml isobaric + 5 mg = 1 ml hyperbaric) + Sufentanil 7,5 µg + Dexametasone 4 mg = 1 ml ; total volume 5 ml
Complementary bolus of 10 mg plane Bupivacaine were required every 90 minutes
Patient-controlled spinal analgesia 48 to 72 hours : Top-ups on demand: Bupivacaine 2,5 mg + 0,1 mg Morphine in 3 ml volume
Results Mean duration of surgery: 180 +/20 min.
Perfect haemodynamic stability and total muscular relaxation were achieved.
Maximum consumption of LA and opiates in the first 24 hours: 7,5 mg Bupivacaine + 0,3 mg morphine.
Pain intensity: VAS 1-2.
Postoperative ileus: 36 h.
PDPH 0.Pruritus: 20%.
Conclusions For major abdominal surgery, CSA is safe and efficient, avoiding general anaesthesia and the use of muscular relaxants, making possible early mobilisation, and active nursing, earlier nutrition and decreasing respiratory morbidity rate.
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