Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

Ellakany, Mohamed

doi:10.4103/0259-1162.134516

Cited by 23 publications

(24 citation statements)

References 28 publications

(30 reference statements)

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“…This is the first study to report the use of “opioid-free” TCSA for elective and urgent abdominal surgery in older patients with comorbidities. Our study confirms that CSA can be used as a primary anesthesiologic method for major abdominal surgery in elderly patients at serious risk for mortality and morbidity with GA [ [12] , [13] , [14] ].…”

Section: Discussionsupporting

confidence: 82%

“…Nevertheless, there are only a few reports in the literature regarding the use of TCSA in abdominal surgery, mainly requiring a higher level of sensorial block [ [12] , [13] , [14] ]. All these series describe a regimen of spinal anesthesia based on a combination of intrathecal local anesthetics and opioids, both intraoperatively and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

“…The possibility of maintaining continuous postoperative spinal analgesia provides optimal pain management, sparing intravenous nonsteroidal anti-inflammatory drugs and opioids. Differently from lumbar spinal anesthesia, the safe use of thoracic spinal anesthesia in high-risk older patients undergoing surgery of the upper abdomen is described in only a few case reports and case series [ [12] , [13] , [14] ]. However, CSA has been implicated in specific complications, such as infection, postdural puncture headache, spinal hematoma, and cauda equina syndrome [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Vincenzi

Starnari

Faloia

et al. 2020

Surgery Open Science

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Background Limited studies have applied thoracic continuous spinal anesthesia in abdominal surgery, relying exclusively on opioids. This retrospective study analyzes 2 different schemes of thoracic continuous spinal anesthesia and postoperative analgesia in elderly patients undergoing major abdominal surgery. Methods A total of 98 patients aged ≥ 75 years were divided into 2 groups. The control group (60 patients) received bupivacaine plus fentanyl, whereas the study group (38 patients) received bupivacaine plus ketamine and midazolam. Both received analogous postoperative continuous intrathecal analgesia. Several perioperative variables were evaluated. Results Spinal anesthesia was performed without complications in all patients. Doses of noradrenaline administered, incidence of respiratory depression, need for intraoperative sedation, and time to first flatus were significantly reduced in the bupivacaine plus ketamine and midazolam group. Conclusion In a population of frail, elderly patients, thoracic continuous spinal anesthesia with local anesthetic plus midazolam and ketamine was superior to local anesthetic plus fentanyl. In the group receiving local anesthetic plus midazolam and ketamine, the incidence of respiratory depression was reduced, and doses of norepinephrine and intraoperative sedating medications were lower. Intraoperative anesthesia and postoperative analgesia were similar in both groups.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Vincenzi

Starnari

Faloia

et al. 2020

Surgery Open Science

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“…Strengths of this method documented in previous works 11 , 17 and confirmed in our series 12–14 rely on improved intraoperative hemodynamic control and perioperative analgesia in addition to avoiding invasive airway management and postoperative mechanical ventilation, leading to fewer negative repercussions on the cardiorespiratory system and decreased perioperative morbidity compared to GA, 2–4 , 6 as well as other potential benefits including a minor risk of local recurrence and distant metastasis by attenuating the immunosuppression associated with the surgical neuroendocrine stress response when applied in oncological surgery. 18 , 19 …”

Section: Discussionmentioning

confidence: 63%

Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases

Vincenzi¹,

Stronati²,

Isidori³

et al. 2022

LRA

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Purpose Few studies have described segmental thoracic spinal anesthesia (STSA) as primary anesthesiologic method in breast and axillary surgery, documenting the association of intrathecal local anesthetics and opioids. This case series reports an opioid-free scheme of STSA in four elderly patients undergoing major breast and axillary oncological surgery. Patients and Methods STSA was performed in three female patients undergoing unilateral mastectomy ± axillary lymph node dissection (ALND) or sentinel lymph node biopsy for invasive ductal carcinoma and in one male patient undergoing ALND for melanoma metastases. The level of needle insertion was included between T6-8, via a median or paramedian approach. Midazolam (2 mg) and ketamine (20 mg) were used as adjuvants for intrathecal sedation, followed by the administration of hypobaric ropivacaine 0.25% at a dose of 8 mg. The level of sensory blockade achieved was comprised between C2-3 and T11-12. Postoperative analgesia was maintained through continuous intravenous administration of Ketorolac by an elastomeric pump (90 mg over 24 hrs.). Results Spinal anesthesia was completed without complications in all patients. Conversion to general anesthesia (GA) and perioperative intravenous sedation were not required. No major postoperative complications and no episodes of postoperative nausea and vomiting (PONV) were reported. No rescue analgesic was administered. All patients were discharged in postoperative day 2 and are alive at 30, 29, 27 and 13 months after surgery, respectively. High grade of satisfaction on the anesthesiologic method was expressed by all cases. Conclusion STSA with local anesthetic plus midazolam and ketamine might be considered a safe and effective alternative to GA, even in surgeries involving the breast and axillary region, particularly in elderly and frail patients. Larger prospective studies are required to validate these findings.

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“…The intubation may have many negative impacts on the pulmonary function due to laryngeal spasm and edema.(M. H. Ellakany, 2014;Khan, Ashraf, & Khan, 2013) Despite the effectiveness of combined spinalepidural anesthesia in the surgical practice, there are some limitations that block practicing this technique, this may include the lack of the organized training courses and the fear that this technique may not work sufficiently. (Clemente & Carli, 2008) The mean age of the patients who were involved in the study was 64.33 years (SD: 12.085).…”

Section: Discussionmentioning

confidence: 99%

Open Cholecystectomy in Respiratory and Cardiovascular disease patients under Lumbar combined Spinal-Epidural Anesthesia

Mohammed

Algumrawi

2021

ZJPAS

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Background and Aims: Regional anesthesia gained popularity over the last three decades due to the technical advances across subdisciplines, better understanding of the physiology, the advances in the field of anesthetic drugs, and the better approach in training for such techniques. The technique is currently used in many anatomical levels and most surgical procedures can be performed using the combined spinal epidural type. The aim of this study is to evaluate the feasibility of the combined spinal-epidural anesthesia in patients with respiratory and cardiovascular diseases who underwent open cholecystectomy. Patients and methods: This prospective cross sectional study which was done on patients undergoing elective open cholecystectomy (n=119) for whom the general anesthesia was contraindicated due to major cardiovascular and pulmonary diseases, under lumber combined spinal-epidural anesthesia. Results: The mean age of our patients was 64.33(SD: 12.085) years; females constituted 73 of them (61.3%) and males 46 (38.7%). Most patients (73) were complaining from the cardiovascular diseases (61.34%). In most patients the onset of the action of the anesthesia was between 10-12 minutes. In 55 patients (46.2%) no extra-drugs were required, and in the rest of patients intravenous mediations were given to relieve anxiety, pain, or both. In 81 patients (68.1%) no intraoperative complications were reported, the most common intraoperative complication was hypotension in 31 patients (26.1%), post-operatively no complications were reported in 86 patients (72%), and hypotension was reported in 12 patients (10.1%), nausea & vomiting in 11 patients (9.2%). The surgeon's satisfaction was excellent in 73.11% of the surgeries, as was good in 23.53%. Most patients gained the lower limb movement within 2 hours. There was a significant correlation between the need for extra drugs and both comorbid diseases and the development of intraoperative complications (P values 0.022 & 0.000) respectively and no significant correlations with other parameters such as the gender, postoperative complications and the surgeon's satisfaction (P values 0.707, 0.522, and 0.056) respectively. Conclusion:The technique of the combined spinal epidural anesthesia is safe and very effective when used for American Society of Anesthesiologist (ASA) patient classification class III and IV patients who need open cholecystectomy. This technique should be used by expert anesthetists who are well trained and gained skill in this technique, and it may be used in fields other than surgery such as trauma victims and for cancer patients.

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Thoracic spinal anesthesia is safe for patients undergoing abdominal cancer surgery

Cited by 23 publications

References 28 publications

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Continuous thoracic spinal anesthesia with local anesthetic plus midazolam and ketamine is superior to local anesthetic plus fentanyl in major abdominal surgery

Opioid-Free Segmental Thoracic Spinal Anesthesia with Intrathecal Sedation for Breast and Axillary Surgery: Report of Four Cases

Open Cholecystectomy in Respiratory and Cardiovascular disease patients under Lumbar combined Spinal-Epidural Anesthesia

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