Spinal Anesthesia for Laparoscopic Cholecystectomy (original) (raw)
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Role of spinal anaesthesia and general anaesthesia during laparoscopic cholecystectomy
Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. The study was done in Shantiram medical college and general hospital, nandyal. 50 healthy patients were randomized under spinal anesthesia (n=25) & General Anesthesia (n=25). Hyperbaric 3ml bupivacaine plus 25mcg fentanyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post-operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance, drugs or converted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 4 patients under spinal anesthesia had right shoulder pain, 1 patients were converted to GA and 3 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post-operative pain relief in spinal group. All the patients were comfortable and surgeons satisfied. Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery, but require cooperative patient, skilled surgeon, a gentle surgical technique and an enthusiastic anesthesiologist.
Laparoscopic cholecystectomy under spinal anesthesia
The American Journal of Surgery, 2008
Background: Advantages of laparoscopic cholecystectomy (LC) such as less pain and short hospital stay make it the treatment of choice for cholelithiasis. There are limited data about LC under spinal anesthesia. This study was designed to evaluate LC under spinal anesthesia. Methods: Twenty-nine patients underwent surgery for LC under spinal anesthesia at the 4th Department of Surgery of the Ankara Numune Education and Research Hospital between April 2005 and January 2006. All patients were informed about spinal anesthesia in detail. The patients also were informed about the risk of conversion to general anesthesia, and all patients provided informed consent. The election criteria for spinal anesthesia were as follows: American Society of Anesthesiologists (ASA) risk group 1 or 2; risk score for conversion from LC to open cholecystectomy (RSCO) less than negative 3; and presence of gallstone disease. Standard laparoscopic technique was applied to all patients. Simple questionnaire forms were developed for both patients and surgeons to provide comments about the operation. Results: The operation was completed laparoscopically on 26 patients, while 3 patients needed general anesthesia due to severe right shoulder pain. None of the patients had cardiopulmonary problems other than transient hypotension during surgery. Intravenous fentanyl (25 g) was needed in 13 patients due to severe right shoulder pain. Five patients still had severe shoulder pain after fentanyl injection. Local washing of the right diaphragm with 2% lidocaine solution was successful in the remaining 5 patients in whom fentanyl injection failed to stop the pain. All of the patients' answers to the questions regarding the comfort of operation were "very well" at the 1-month postoperative evaluation. All surgeons stated that there was no difference from LC under general anesthesia. Conclusions: All of the patients and surgeons were satisfied with LC under spinal anesthesia. Therefore, LC under spinal anesthesia may be an appropriate treatment choice to increase the number of patients eligible for outpatient surgery.
Laparoscopic Cholecystectomy: A Comparison between Spinal Anaesthesia and General Anaesthesia
Scholars journal of applied medical sciences, 2021
Original Research Article Introduction: Laparoscopic cholecystectomy is the treatment of choice for the surgical removal of diseased gall bladder. It is a negligibly invasive procedure with a considerably shorter hospital stay and an earlier recovery compared with the classical open cholecystectomy. Anesthetic agents offer an alternative to general anesthesia for short-duration surgical procedures, especially ambulatory surgeries. Objectives: The aim of the study was to compare the effectiveness of spinal anaesthesia with that of general anaesthesia in Laparoscopic Cholecystectomy operation in healthy patient. Methods: This comparative clinical study was conducted in the Department of Anesthesia, Rajshahi Medical College Hospital, Rajshahi, Bangladesh during the period from January 2020 to December 2020. A total of 60 patients aged between 18-65 years of both sex with ASA Grade status I and II undergoing elective laparoscopic Cholecystectomy were randomly selected for the study and the patients were divided into two groups; Group I(n=30) received general anaesthesia and Group II(n=30) received spinal anaesthesia. Intraoperative parameters, postoperative pain, complications, recovery and cost were compared between both groups. Statistical analysis of the results was obtained by using window-based computer software devised with Statistical Packages for Social Sciences (SPSS-22). Results: Majority patients were male and mean age was 36.67 in Group I, 34.58 in Group II. Mean Pulse Rate (MPR) of Group I was 86 in pre-operative, 98 before insufflation, and 114 after insufflation. Highest comparison of the mean pulse rate 115 belongs to Group I and lowest mean pulse rate 94 belong to Group II after insufflation. Lowest 122 systolic blood pressure (mean) in Group II and highest 135 systolic blood pressure (mean) in Group I also after insufflation. On the other hand, Perioperative comparison of SpO 2 was lowest 95% and highest 98% of Group I and Group II respectively after 4 hours. Conclusion: Laparoscopic cholecystectomy can be safely performed under spinal anaesthesia. Spinal anaesthesia was associated with an extremely low level of postoperative pain, better recovery and lower cost than general anaesthesia. Postoperative complications like nausea, vomiting and dizziness were also less in spinal anaesthesia.
Archives of Surgery, 2008
To compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. Design: Controlled randomized trial. Setting: University hospital. Patients: One hundred patients with symptomatic gallstone disease and American Society of Anesthesiologists status I or II were randomized to have laparoscopic cholecystectomy under spinal (n=50) or general (n=50) anesthesia. Methods: Intraoperative parameters, postoperative pain, complications, recovery, and patient satisfaction at follow-up were compared between the 2 groups. Results: All the procedures were completed by the allocated method of anesthesia, as there were no conversions from spinal to general anesthesia. Pain was significantly less at 4 hours (PϽ.001), 8 hours (P Ͻ.001), 12 hours (P Ͻ .001), and 24 hours (P = .02) after the procedure for the spinal anesthesia group compared with those who received general anesthesia. There was no difference between the 2 groups regarding complications, hospital stay, recovery, or degree of satisfaction at follow-up. Conclusions: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.
Annals of surgical treatment and research, 2017
Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC. Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups. Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in...
IP innovative publication pvt. ltd, 2019
General anaesthesia has been technique of choice for laparoscopic surgeries. Given the advantages of spinal anaesthesia, we conducted a study to see feasibility of spinal anaesthesia in laparoscopic cholecystectomy in respect to cardiovascular and respiratory stability and post operative outcome. After obtaining institutional ethical committee approval, sixty consenting patients for laparoscopic cholecystectomy were randomized into two groups to receive spinal or general anaesthesia. Spinal anaesthesia was given with 0.5% bupivacaine heavy and 1μg/kg clonidine. General anaesthesia group received standard general anaesthesia with endotracheal intubation and positive pressure ventilation. Intraoperative haemodynamics, end tidal and arterial CO2, postoperative analgesia, satisfaction scores and complications were compared. As per Student t test and Chi square tests demographic, surgical duration, haemodynamic parameters were comparable. Perioperative PaCO2 was stable and comparable. 24 hr visual analog pain scores, tramadol consumption were significantly less in spinal group. Incidence of postoperative nausea and shoulder tip pain was less than 6% in spinal group. Both groups had good patient and surgeon acceptance. Conclusion: Laparoscopic cholecystectomy can be safely performed under spinal anesthesia and provides good hemodynamic and respiratory stability, requires less postoperative analgesia and better patient and surgeon satisfaction.
Anesthesia for Laparoscopic Cholecystectomy: Experience with 5000 Cases
Annals of International medical and Dental Research, 2016
Background: Since the introduction of laparoscopic cholecystectomy in 1987 by Philips Mouret its popularity has increased tremendously and very rapidly because of its several advantages. But reports of randomized large control series are not yet available so we plan to report our experience of 5000 cases of single incision laparoscopic cholecystectomies and their anesthetic management. Objective: The purpose of this retrospective study was to evaluate the general anesthetic technique for laparoscopic cholecystectomy keeping in mind the pathophysiological effect of laparoscopy, head up position and pneumoperitoneum. Methods: A retrospective study of 5000 cases of symptomatic gall bladder disease that underwent laparoscopic cholecystectomy at Nobel Medical College Teaching Hospital, Nepal from Jan 2010-Dec 2015 was done. Detail pre-anesthetic check up, investigation, preparation and anesthetic techniques were carried out as per hospital protocol. Strict vigil was made to maintain the vital parameters within normal limit particularly ETCO2 below 35 mmHg. All efforts were made to keep ETCO2 below 35mHg. At the end of surgery residual neuromuscular blockade was reversed with neostigmine and glycopyrrolate, before they were transferred to PACU. Results: The mean age of the patients was 48 years with a male:female of 1:2.26. 28.64 % of patients belonged to ASA III. More than 95 % patients maintained SPO2 between 98-100% and 91% maintained their ETCO2 below or around 35 mmHg. Intra-operative surgical and anesthetic complications were controlled with proper therapies. There was no intra-operative death. Conclusion: Single incision laparoscopic Cholecystectomy (SILC) is a safe, cost effective ideal for day care surgery and general anesthesia with controlled mechanical ventilation with oxygen, air, fentanyl, isoflurane, midazolam and vecuronium/atracurium is good choice.
2013
Objective: To study the effectiveness of SA (Spinal anesthesia) for open cholecystectomy as compared to GA (General anesthesia) in terms of reducing post operative pain, analgesia requirement, respiratory complications and length of hospital stay. Study Design: Quasi Experimental Study Place and Duration: POF Hospital, Wah Cantt from January 2009 to December 2010 Materials and Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy were randomly divided into two groups. SA Group received Spinal anesthesia (SA) with hyperbaric bupivacaine intrathecally and GA Group received General anesthesia (GA) with propofol, fentanyl, atracurium and sevoflurane during open cholecystectomy. The main end points of the study were post operative pain free interval, analgesia requirements, respiratory complications and length of hospital stay in both the groups. Results: 102 patients were admitted with symptomatic cholelithiasis from January 2009...
Low dose spinal anesthesia for open cholecystectomy: a feasibility and safety study
International Surgery Journal, 2017
Background: Cholecystectomy is performed either open or a laparascopic route. the traditional and invasive open cholecystectomy is still in frequent practice for various reasons. Spinal anesthesia (SA) has been widely used as alternative to General Anesthesia (GA) for laparoscopic cholecystectomy. SA could be a safe and effective anaesthetic procedure for open cholecystectomy. This study was conducted to uncover feasibility and safety of low dose SA for conducting open cholecystectomy.Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy received SA using 2 ml of 0.5% hyperbaric Bupivacaine mixed with 100 µg Morphine. Peri-operative preparations and management were all standardized. Other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. Open cholecystectomy by right oblique incision. Intra-operative events and post-operative events were observed for 48 hours, operati...
Spinal anaesthesia for laparoscopic cholecystectomy: A feasibility and safety study
Background: Regional anaesthetic techniques have benefi ted those patients undergoing laparoscopic surgeries that are deemed high risk to receive general anaesthesia (GA). But spinal anaesthesia (SA) has not been routinely employed as the sole technique for laparoscopic cholecystectomy (LC). Objective: This study was conducted to uncover feasibility and safety of SA for conducting LC. Materials and methods: Twelve American Society of Anaesthesiologists' physical status I or II patients undergoing elective LC received SA using 4 ml of 0.5% hyperbaric Bupivacaine mixed with 0.15 mg Morphine. Peri-operative preparations and management were all standardised, with other drugs being only administered to manage anxiety, pain, nausea/vomiting, hypotension, and any adverse event. LC was performed with CO 2 pneumoperitoneum maintained at an intra-abdominal pressure of less than 10 mm Hg and with minimal operating table tilt. Peri-operative events, operative diffi culty, hospital stay and patient satisfaction were studied. Results: Spinal anaesthesia was adequate for surgery in all but one patient. Intraoperatively, two out of four patients who experienced right shoulder pain received Fentanyl. Two patients were given Midazolam for anxiety and one was given Ephedrine for hypotension. Operative diffi culty scores were minimal and surgery in one patient was converted to open cholecystectomy. Postoperatively, pain scores were minimal and no patient demanded opioid. One patient required antiemetic for vomiting and one patient each suffered headache and urinary retention. 11 patients were discharged within 48 hours of surgery and patient satisfaction scores were very good. Conclusion: Spinal anaesthesia with Morphine-mixed hyperbaric Bupivacaine is adequate and safe for elective LC in otherwise healthy patients and minimises postoperative pain and opioid use. Success and safety of this technique, however, necessitates knowledgeable patient, gentle surgical procedure, and cooperation among patient and members of the perioperative care team.