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%

Nausea 20%

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