title: Transrectal-HIFU as primary minimally-invasive option for localized prostate cancer. Is spinal anaesthesia cost-effective? A single centre experience in over 100 patients.
abstract: BACKGROUND
  The management of Prostate cancer (PC), since PSA testing has been introduced in the clinical practice, has been significantly spoiled by a "leading-time bias" effect. As a consequence, this has brought to a dramatic diagnosis anticipation at the 4th-5th decade of life in sexually active and otherwise asymptomatic men. Standard options as radical prostatectomy or EBRT are hampered by a significant negative impact on patient's QoL. More recently several alternative minimally-invasive ablative treatment modalities have been proposed with promising results. Among these, TR-HIFU (Trans-Rectal High Intensity Focused Ultrasound) is playing a growing role in the treatment of localized low-intermediate risk PC, although long-term oncologic outcome are still awaited. In order to achieve an optimal result, a specific TR-HIFU's requirement is given by an unchanging target throughout the whole procedure. Therefore, the ideal anaesthesia should be either minimally-invasive and allow to get a motionless target up to 3-4 hours. A retrospective evaluation of efficacy and safety of a spinal anaesthesia in this patient's setting was done.
  
  
  METHODS
  107 patients with localized prostate cancer treated in our institution from October 2004 to December 2007 with TR-HIFU procedure received a subarachnoidal anaesthesia with combined administration of 0.5% normobaric racemic bupivacaine (15 to 17.5 mg) and sufentanil 5 microg.
  
  
  RESULTS
  This technique allowed covering the whole TR-HIFU procedure (analgesia and motor blockade up to 4-5 hours). It was well tolerated by patients who only rarely required additional sedative or analgesics. A low anaesthesia-related side effects rate, as arterial hypotension, nausea and vomiting, and no severe side effects of intrathecal opioids, as deep sedation, bradycardia, myosis, bradypnea and oxygen desaturation, occurred. Intraoperative employment of sedatives and postoperative need of analgesics was low.
  
  
  CONCLUSIONS
  Using a low-dose intrathecal sufentanil an effective spinal block either on the sensitive and motor pathways was provided. Patients' tolerance to the procedure was good and the side-effect rate low. No adverse reactions to intrathecal sufentanil 5 microg were observed. In our experience TR-HIFU can be performed with neuraxial block in most of the cases and it's associated to a favorable cost-benefit rate.
authors.affiliation: S.C. Anestesia A, Presidio Ospedaliero S. Giovanni Bosco ASL 4 - Torino. grospaul2002@yahoo.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Grosso
authors.forename: Leonardo
authors.initials: L
authors.lastname: D'Urso
authors.forename: Devis
authors.initials: D
authors.lastname: Collura
authors.forename: Raffaella
authors.initials: R
authors.lastname: Citro
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Grassano
authors.forename: Rosanna
authors.initials: R
authors.lastname: Macchiarulo
authors.forename: Luca
authors.initials: L
authors.lastname: Rivalta
authors.forename: Cristina
authors.initials: C
authors.lastname: Valz
authors.forename: Giovanni
authors.initials: G
authors.lastname: Muto
authors.forename: Enrica
authors.initials: E
authors.lastname: Guglielmotti
authors.forename: Enrica
authors.initials: E
authors.lastname: Guglielminotti
mesh_terms: D000759:Adjuvants, Anesthesia / Q000191:economics; D000368:Aged; D000775:Anesthesia, Spinal / Q000191:economics* / Q000379:methods*; D000779:Anesthetics, Local / Q000191:economics*; D002045:Bupivacaine / Q000191:economics*; D003362:Cost-Benefit Analysis; D004359:Drug Therapy, Combination; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000628:therapy*; D011788:Quality of Life; D012189:Retrospective Studies; D013346:Subarachnoid Space; D017409:Sufentanil / Q000191:economics*; D016896:Treatment Outcome; D036761:Ultrasound, High-Intensity Focused, Transrectal / Q000295:instrumentation
chemical_list: D000759:Adjuvants, Anesthesia; D000779:Anesthetics, Local; D017409:Sufentanil; D002045:Bupivacaine