Purpose. Renal and hepatic functions decline with age, but little is known about the renal and hepatic effects of the inhaled anaesthetic sevoflurane in the elderly. We therefore compared the renal and hepatic effects of sevoflurane anaesthesia in elderly patients with and without lumbar epidural block with respect to renal and hepatic functions, stress response, blood loss, sevoflurane consumption and postoperative pain.Methods. Forty patients aged 65 years or older undergoing radical cystectomy with ileal loop diversion under general anaesthesia combined with or without epidural anaesthesia were randomly assigned to receive either sevoflurane alone ( Sevoflurane group) (n = 20) or sevoflurane with epidural block (Combined group) (n = 20). Blood and urine samples were collected before, during, and after anaesthesia. Serum inorganic fluoride, renal function tests, liver function tests, serum and urinary alfa glutathione-s-transferase (α -GST), cortisol and adrenocorticotrophic hormone (ACTH ) were performed. Also sevoflurane consumption, amount of blood loss and postoperative pain were measured. Results. Serum inorganic fluoride was significantly elevated in both groups. The production of inorganic fluoride was significantly greater in the sevoflurane group, but the level did not exceed 50umol/l in any patient. No abnormalities were observed in blood urea nitrogen (BUN), serum and urine creatinine, creatinine clearance, serum bilirubin, AST, ALT, or alkaline phosphatase in either group. Alfa glutathione-s-transferase (α –GST) was increased both in urine and serum during and for a short period after anaesthesia indicating mild transient renal and hepatic impairment. Conclusion. We found that sevoflurane alone or in combination with epidural anaesthesia resulted in similar degrees of mild, transient tubular and hepatic functional impairment in elderly surgical patients as evidenced by elevated urinary and serum α-GST respectively. However, no abnormalities were found in routine laboratory tests, suggesting that sevoflurane does not seriously affect renal or hepatic functions in the elderly. In addition, the combined epidural and general anaesthesia had the advantage of decreasing perioperative stress response, blood loss and blood transfusion, sevoflurane consumption, postoperative analgesic requirements and postoperative pain.