Spinal vs General Anesthesia for Laparoscopic Cholecystectomy: Interim Analysis of a Controlled Randomized Trial—Invited Critique (original) (raw)
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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.
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.
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...
Spinal Anesthesia for Laparoscopic Cholecystectomy
In 1985, the first laparoscopic cholecystectomy was performed, and the introduction of laparoscopic cholecystectomy proved to be a new era in the management of cholelithiasis. In his only start, only patients who were good surgical risks, with non acute disease and no prior abdominal surgeries were selected for the procedure. However, as experience was gained, the pool of patients expanded to encompass those who were otherwise candidates for conventional cholecystectomy. To perform the surgery laparoscopically, there is a need to create a space between the abdominal wall and the viscera. If cholecystectomy was performed under anesthesia in high-risk patients, there is no explanation for the procedure to become routine in healthy patients. Spinal anesthesia has the advantage of providing analgesia and muscle relaxation with complete preservation of consciousness and rapid postoperative recovery. No need to change the surgical technique, only that the inflation pressure should be maintained between 8 and 10 mmHg. One of the problems is the appearance of shoulder pain, which can be seamlessly decreased with low intra-abdominal pressures and systematic use of intraperitoneal local anesthetics. Spinal anesthesia reduces the incidence of nausea and vomiting and improves postoperative pain and allows early ambulation and discharge. The cost of spinal anesthesia was 30% of general anesthesia.
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...
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.
Objectives: Effective post-operative pain control is an essential component of care of surgical patients. Various analgesic regimens have been used to ensure adequate postoperative pin relief. We conducted this study to compare the efficacy of spinal anesthesia versus general anesthesia regarding post-operative pain following laparoscopic cholecystectomy. Methodology: After approval of the hospital ethical committee, 120 females were included in our randomized, control trial from 1 July 2015 to 31 Dec 2015. Patients were explained about the study and informed consent was signed by them or their guardians. Patients were randomly divided into two groups; in Group-A patients, spinal anesthesia was achieved with 3 ml 0.5% hyperbaric bupivacaine hydrochloride and 25 µg fentanyl. Group-B was given GA. All the patients were premedicated with IV metoclopramide 10 mg and dexamethasone 8 mg; preemptive analgesia with 0.1 mg/kg nalbuphine was done. Induction of GA was done with propofol 2 mg/kg, muscle relaxation was achieved with atracurium besylate 0.5 mg/kg. Endotracheal intubation with 6.5 or 7 mm cuffed tube was done, Visual analogue scale (VAS) was used to assess pain severity at immediate post-operative period (S-0) and at 6 hours (S-6). Data was analyzed using SPSS version 16.0. For quantitative variables like pain score and age, mean and standard deviation (SD) were calculated. For qualitative variables like severity of pain, frequency and percentages were calculated. Chi-square test was used to measure frequency of pain between two groups. P-value < 0.05 was taken as significant. Results: The two groups did not differ in demographic profiles. At S-0, the mean score in Group-A was 2.89 ± 2.49 (mode = 1, median 2) versus 3.83 ± 2.56 (mode = 3, median = 3), p value 0.0364. At zero hours (S-0); 6 (10%) patients in Group-A had no pain (VAS less than 2), 28(46.6%) patients had mild pain and 26 (43.3%) patients had severe pain. In Group-B 8(13.3%) had no pain, 20(33.3%) had mild pain and 32(55%) patients had severe pain. The p value was 0.947, which is statistically insignificant. At S-6, the mean VAS was 6.94 (median = 7, mode = 8) in Group-A versus 6.23 ± 2.11 (median = 6, mode = 5) in Group-B, p value 0.0277. At six hours (S-6), 31(51.6%) patients no mild pain in Group-A, 24(40%) had mild pain and 5(8.3%) had severe pain. Whereas 30 (50%) patients had no pain, 8 (13.3%) patients had mild pain and 22 (36.6%) patients had severe pain in Group-B. The p-value was 0.022, which is statistically significant. Conclusion: Our study has shown that single shot spinal anesthesia provides better postoperative analgesia in the postsurgical period. The addition of intrathecal fentanyl provides adequate analgesia, including relief from shoulder tip pain. So, spinal anesthesia can be safely used as sole anesthesia for laparoscopic cholecystectomy.
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.
The Journal of Medical Research, 2018
Introduction: General anaesthesia is choice of laparoscopic cholecystectomy (GA). Spinal anaesthesia is usually preferred in patients where general anaesthesia is contraindicated. In this study, the Spinal anaesthesia was used in 67 patients in whom LC was planned (study group). Methods: Laparoscopic cholecystectomy(LC) has been conventionally done under general anaesthesia. Regional anaesthesia is usually preferred in patients where GA is contraindicated. Spinal anaesthesia was used in 67 patents for laparoscopic cholecystectomy (study group). 50 patients were given GA as control group. There was no modification in the technique, and the intra-abdominal pressure was kept 8mm of Hg to10 mm of Hg. Sedation was given if required, and conversation to general anaesthesia was done in patients not responding to sedation or with failure of spinal anaesthesia. Results: Out of 67 patients, two patients required conversation to GA. Hypotension requiring support was recorded in 14 (20.89%) patients and 16(23.88%) experienced neck or shoulder pain or both.Postoperatively,2(2.9%) patients had vomiting as compared 17(34%) of patients who were administered GA. Injectable diclofenac was required in 25(37.3%) of patients for abdominal pain within 2hours postoperatively and oral analgesic 53(79.10%) patients within the first 24 hours in SA group. However, 96% of patients operated under GA required injectable analgesics in the immediate postoperative period. Postural headache was experienced by 5(7.46%) patients post-operatively. Average time of discharge was 1.9 in patients operated under S.A compared to2.1 days in G.A group. Conclusion: There is no risk of intubation-related airway obstruction, little risks of unrecognized hypoglycaemia in a diabetic patient, excellent muscle relaxation, decreased surgical bed oozing and a more rapid return of gut function when laparoscopic cholecystectomy is done using SA compared with GA.
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...