Ann Surg Treat Res.  2017 Mar;92(3):136-142. 10.4174/astr.2017.92.3.136.

Laparoscopic cholecystectomy under spinal-epidural anesthesia vs. general anaesthesia: a prospective randomised study

• Donmez T
• Erdem VM
• Uzman S
• Yildirim D
• Avaroglu H
• Ferahman S
• Sunamak O

• KMID: 2377555
• DOI: http://doi.org/10.4174/astr.2017.92.3.136

Abstract

PURPOSE
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.
METHODS
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.
RESULTS
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 CSEA group (25% vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2% vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group.
CONCLUSION
CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.

Keyword

Laparoscopic cholecystectomy; General anesthesia; Epidural anesthesia; Spinal anesthesia

MeSH Terms

Anesthesia*
Anesthesia, Epidural
Anesthesia, General
Anesthesia, Spinal
Cholecystectomy, Laparoscopic*
Fentanyl
Headache
Humans
Hypotension
Incidence
Pain, Postoperative
Pneumoperitoneum
Postoperative Nausea and Vomiting
Prospective Studies*
Shoulder Pain
Urinary Retention
Fentanyl

Figure

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  Fig. 1 Flowchart diagram of the study.

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