Background and Aims Recurrent cancer and metastases depend on the perioperative immune competence which is impared by Surgery , Anaesthesia and Opiates
CSA attenuates the surgical stress response and decreases anaesthetic requirements affording rapid rehabilitation and good early and late outcome
Methods 78 ASA I-III patients age ranged from 38 to 84 underwent awake open or laparoscopic abdominal surgery for cancer : gastrectomy , colectomy, radical prostatectomy , cystoprostatectomy , hysterectomy under CSA
Puncture between L2-L3 in the lateral decubitus ; a 23G spinal catheter over a 27G Whitacre needle ( Wiley Spinal) was introduced 3 cm intratechally
First dose 20 mg plane Bupivacaine + 10 µg Sufentanyl + 4 mg Dexamethasone in a total volume of 5 ml
Complementary boluses of 10 mg Bupivacaine were required every 90 mins
Patient controlled spinal analgesia 48 to 72 hours : Top ups on demand Bupivacaine 1,25 mg + 0,1 mg Morphine in 3 ml volume every 12 hours
Results Mean duration of surgery 180 mins with perfect hemodynamic stability and surgical confort
Maximum consumption of LA and opiates in the first postoperative 36 hours : 3,75 mg Bupivacaine and 0,3 mg Morphine
Postoperative ileus maximum 24 h
PDPH 0 Pruritus 10%
Conclusions Major abdominal surgery under CSA is technically feasible , safe and efficient avoiding GA and the use of curares , opiates and Noradrenaline .
It makes possible early mobilisation , active nursing , earlier nutrition and decreases respiratory morbidity rate .
Excellent immediate and late outcome with high patients satisfaction
Significant cost -effectiveness
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.