Castellani Daniele, Starnari Roberto, Faloia Lucia, Stronati Massimo, Venezia Alfredo, Gasparri Luca, Claudini Redi, Branchi Alessandro, Giampieri Marina, Dellabella Marco
Department of Urology, IRCCS INRCA, via Della Montagnola 81, 60127 Ancona, Italy.
Department of Anesthesiology, IRCCS INRCA, Ancona, Italy.
Ther Adv Urol. 2018 Sep 3;10(11):343-349. doi: 10.1177/1756287218795427. eCollection 2018 Nov.
Radical cystectomy (RC) is the gold standard therapy in nonmetastatic muscle-invasive bladder cancer and is usually performed under general anesthesia (GA). GA is high risk in most older patients due to comorbidities. Continuous spinal anesthesia (CSA) may be an alternative solution to reduce postoperative morbidity in elderly. The aim of this study was to assess the feasibility, morbidity, and mortality of RC performed under CSA in octogenarian patients.
We retrospectively reviewed data of five frail patients aged ⩾80 who underwent RC in CSA. CSA was achieved starting with 2.5 mg hyperbaric bupivacaine plus 25 µg fentanyl. Postoperative analgesia was achieved through the intrathecal catheter, using continuous delivery of levo-bupivacaine 60 mg plus fentanyl 75 µg in 72 hours.
Surgery was completed in all cases in CSA. No patients required postoperative intensive care unit admission. Complications were Clavien I for four in three patients, Clavien II for seven in five patients, and Clavien IIIb for one patient. Postoperative consumption of painkillers was negligible. Oral feeding resumed within 3 days in all cases. The mean postoperative stay was 9.6 days. All patients were alive at 3 months of follow up.
Management of muscle-invasive bladder cancer (MIBC) in older patients is becoming an important issue due to the continuous aging of the population. Age should not preclude RC, but careful management is mandatory because perioperative morbidity and mortality are increased in the elderly. Our preliminary results show that CSA and analgesia is a feasible option as an additional way to reduce morbidity and mortality in frail octogenarians who require RC.
根治性膀胱切除术（RC）是治疗非转移性肌层浸润性膀胱癌的金标准疗法，通常在全身麻醉（GA）下进行。由于合并症，GA对大多数老年患者来说风险较高。连续脊麻（CSA）可能是降低老年患者术后发病率的一种替代方案。本研究的目的是评估在CSA下对八旬老人进行RC的可行性、发病率和死亡率。
我们回顾性分析了5例年龄≥80岁、在CSA下接受RC的体弱患者的数据。通过2.5mg高压布比卡因加25μg芬太尼开始实施CSA。术后镇痛通过鞘内导管实现，在72小时内持续输注左旋布比卡因60mg加芬太尼75μg。
所有病例均在CSA下完成手术。没有患者需要术后入住重症监护病房。并发症方面，3例患者中有4例为Clavien I级，5例患者中有7例为Clavien II级，1例患者为Clavien IIIb级。术后止痛药的消耗量可忽略不计。所有病例均在3天内恢复经口进食。术后平均住院时间为9.6天。所有患者在随访3个月时均存活。
由于人口持续老龄化，老年患者肌层浸润性膀胱癌（MIBC）的管理正成为一个重要问题。年龄不应成为进行RC的障碍，但必须进行仔细管理，因为老年人围手术期的发病率和死亡率会增加。我们的初步结果表明，CSA和镇痛作为一种额外的方法，对于需要RC的体弱八旬老人来说，是降低发病率和死亡率的可行选择。
