title: Feasibility of radical cystectomy in exclusive spinal and/or epidural anaesthesia.
abstract: OBJECTIVE
  Muscle invasive bladder cancer can be found predominantly in elderly people with a high likelihood of suffering from concomitant diseases; especially in these patients, the risks associated with general anaesthesia during radical cystectomy can be the limiting factor of performing an otherwise indicated radical operation. To overcome this limitation, we analysed the feasibility of performing radical cystectomy in exclusive spinal and/or epidural anaesthesia.
  
  
  METHODS
  Between March and June 2010, nine patients underwent radical cystectomy in exclusive spinal and/or epidural anaesthesia. These patients were either not willing or unfit to undergo radical cystectomy in general anaesthesia. A continent urinary diversion (ileum neobladder) and an ileum-conduit were performed in five patients and four patients, respectively. The feasibility of radical cystectomy in regional anaesthesia was tested using a variety of parameters.
  
  
  RESULTS
  All nine procedures could be performed under strict regional anaesthesia. Mean operation time was 206 min (range 146-265 min), mean intraoperative blood loss was 622 ml (range 200-1,500 ml), mean postoperative time at intermediate care was 1 day (range 0-3 days) and mean length of hospital stay was 21.8 days (range 17-26 days). Analgesics of the WHO class I, II and III were applied for 5.7, 1.2 and 2.8 days mean, respectively.
  
  
  CONCLUSIONS
  Performance of radical cystectomy in exclusive spinal and/or epidural anaesthesia is feasible and can be considered particularly in those patients who would be otherwise unfit to undergo radical cystectomy in general anaesthesia. This new operative and anaesthesiological concept could also play an important role in new fast track regimens.
authors: Department of Urology, Ludwig-Maximilians-University, LMU, Marchionistr. 15, 81377, Munich, Germany, alexander.karl@med.uni-muenchen.de.
authors: A
authors: A
authors: Karl
authors: B
authors: B
authors: Schneevoigt
authors: E
authors: E
authors: Weninger
authors: T
authors: T
authors: Grimm
authors: C
authors: C
authors: Stief
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000767:Anesthesia, Epidural; D000775:Anesthesia, Spinal; D016063:Blood Loss, Surgical; D015331:Cohort Studies; D015653:Cystectomy / Q000379:methods*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome; D001749:Urinary Bladder Neoplasms / Q000601:surgery*