DOI: https://doi.org/10.22141/2224-0586.2.73.2016.74775

The Use of Regional Anesthesia in Radical Cystectomy in Muscle-Invasive Bladder Cancer Patients

O.S. Garmish, K.A. Fomchenko, S.I. Zabashny, R.N. Molchanov, Yu.Yu. Kobelyatskyi

Abstract


To date, regional anesthesia in radical cystectomy in bladder cancer patients is performed as a component of a multi-component intravenous anesthesia in ventilated patients.
The goal is to assess the safety and benefits of performing ra­dical cystectomy using the combined spinal-epidural anesthesia (CSEA), while maintaining spontaneous breathing with subsequent evaluation of postoperative period.
Materials and methods. From 2008 to 2012 radical cystectomy with extended pelvic lymphadenectomy and different types of urinary diversion with the CSEA was performed in 96 patients aged 67,0 ± 6,5 years old. Postoperative analgesia consisted of prolonged infusion of naropine 0.2% — 6.8 ml/h in combination with systemic administration of non-steroidal anti-inflammatory drugs. Characteristics of heart rate variabi­lity (HRV) in the frequency domain were evaluated.
Results and conclusions. Development of spinal block was associated with decreased total spectral power, mainly sympathetic activity spectrum (LF) due to sympathetic blockade, less pronounced inhibition of parasympathetic nervous system. Density spectrum of activity of the subcortical neural centers and humoral regulation processes (VLF) were not significantly altered until the patient sedation. Hemodynamics was characterized by an increase in cardiac index (CI) of 15.9 %, decrease in the index of total peripheral vascular resistance (IТPVR) by 23.2 %.
Introduction of hypnotics leads to a further reduction of the spectral power in the LF band and statistically significant suppression of the total spectral power spectrum VLF. These changes of vegetative homeostasis were accompanied by reduced blood pressure, CI, on the background of unreliable increasing of IТPVR.
Application of sub-hypnotic doses of propofol in order to achieve drug-induced sleep provides more stable hemodyna­mics and autonomic homeostasis compared with the use of benzodiazepines.
CSEA is the method of choice of anesthesia when performing radical cystectomy. Prolonged postoperative epidural analgesia with 0.2% naropine provides as early as possible mobilization of patients, followed by early recovery of the gastrointestinal tract motility and passage, reduces the risk of respiratory and thromboembolic complications.


Keywords


bladder cancer; cystectomy; regional anesthesia

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