Combined spinal and epidural anaesthesia for open radical cystectomy: A controlled study

Maria Galletta; Maria De Pasquale; Alessandro Buttitta; Silvia Viganò; Giuseppe Mucciardi; Gianluca Giannarini; Vincenzo Ficarra

doi:10.1002/bco2.221

Combined spinal and epidural anaesthesia for open radical cystectomy: A controlled study

BJUI Compass. 2023 Oct 3;5(1):101-108. doi: 10.1002/bco2.221. eCollection 2024 Jan.

Authors

Maria Galletta¹, Maria De Pasquale¹, Alessandro Buttitta², Silvia Viganò², Giuseppe Mucciardi², Gianluca Giannarini³, Vincenzo Ficarra²

Affiliations

¹ Gaetano Barresi Department of Human and Paediatric Pathology, Anaesthesiology Section University of Messina Messina Italy.
² Gaetano Barresi Department of Human and Paediatric Pathology, Urology Section University of Messina Messina Italy.
³ Urology Unit Santa Maria della Misericordia University Hospital Udine Italy.

Abstract

Objectives: To evaluate the feasibility of loco-regional anaesthesia and to compare perioperative outcomes between loco-regional and standard general anaesthesia in patients with bladder cancer undergoing open radical cystectomy (ORC).

Patients and methods: A single-surgeon cohort of 60 consecutive patients with bladder cancer undergoing ORC with an enhanced recovery after surgery protocol between May 2020 and December 2021 was analysed. A study group of 15 patients operated on under combined spinal and epidural anaesthesia was compared with a control group of 45 patients receiving standard general anaesthesia. Intraoperative outcomes were haemodynamic stability, estimated blood loss, intraoperative red blood cell transfusion rate, and anaesthesia time. Postoperative outcomes were pain assessment 24 h after surgery, time to mobilisation, return to oral diet, time to bowel function recovery, length of stay and rate of 90-day complications.

Results: No patients required conversion from loco-regional to general anaesthesia. All patients in both groups were haemodynamically stable. No significant differences between groups were observed for all other intraoperative outcomes, except for a shorter anaesthesia time in the study versus control group (250 vs. 290 min, p = 0.01). Pain visual score 24 h after surgery was significantly lower in the study versus control group (0 vs. 2, p < 0.001). No significant differences were observed for all other postoperative outcomes, with a comparable time to bowel function recovery (5 days in each group for stool passage), and 90-day complication rate (46.6% vs. 42.2% for the study vs. control group, p = 0.76).

Conclusion: Our exploratory, controlled study confirmed the feasibility, safety and effectiveness of a pure loco-regional anaesthesia in patients with bladder cancer undergoing ORC. No significant differences were observed in intra- and postoperative outcomes between loco-regional and general anaesthesia, except for a significantly shorter anaesthesia time and greater pain reduction in the early postoperative period for the former.

Keywords: bladder cancer; complications; epidural anaesthesia; general anaesthesia; radical cystectomy; spinal anaesthesia; urinary diversion.