Continuous Epidural Versus Continuous Spinal Anesthesia for Elderly Patients Undergoing Radical Cystectomy: A Comparative Study

Abstract

Background: Bladder cancer is common in geriatrics who have high operative risk and less tolerability to surgical stresses. This study aims at comparing epidural versus continuous spinal anesthesia for elderly patients undergoing radical cystectomy regarding hemodynamics, total volume of bupivacaine used, patient's and surgeon's satisfactions and incidence of complications. Patient and Methods: Twenty male patients divided into 2 equal groups. Group I received continuous epidural anesthesia, 1-1.5 ml/segment of isobaric bupivacaine 0.5%+25µg fentanyl were injected to achieve T4 block then maintenance by 5 ml/h of isobaric bupivacaine 0.5% after 2 segment regression. Group II received continuous spinal anesthesia, 7.5 mg hyperbaric bupivacaine 0.5%+25µg fentanyl were injected. If T4 block wasn't achieved after 15 minute, 2.5 mg of hyperbaric bupivacaine 0.5% was given also during surgery 2.5 mg of hyperbaric bupivacaine 0.5% was given after 2 segment regression to maintain T4 block. Results: Mean age of both groups was comparable. Heart rate showed a significant decrease at 15 minutes after local anesthetics injection in group II (69.90±5.45 vs 76.70±4.97), while no significant differences were recorded later. Group I showed a statistically significant decrease in MAP in mmHg at 10 min (71.93 vs 92.63), at 35 min (65.07 vs 87.83), at 135 min (71.47 vs 84.00), and at 255 min (69.63 vs 80.23). Total dose of bupivacaine was significant smaller in the group II (44.45±4.34mg versus 260.00±21.08mg). Conclusion: Continuous spinal anesthesia has advantage of more hemodynamic stability with adjustable lower dose of injected local anesthetic and excellent patients' and surgeons' satisfaction.