Comparative study between general and thoracic spinal anesthesia for laparoscopic cholecystectomy

Abstract

BackgroundLaparoscopic cholecystectomy is usually done under general anesthesia, but many patients with major medical problems sometimes cannot tolerate such anesthesia, and thoracic spinal anesthesia may be beneficial in such patients. A comparative study between two groups of patients submitted to laparoscopic cholecystectomy using either general anesthesia or segmental thoracic spinal anesthesia.Patients and methodsForty patients classified according to American Society of Anesthesiology (ASA) as class I or II undergoing laparoscopic cholecystectomy, divided into two groups, 20 patients each. Group G received conventional general anesthesia with endotracheal intubation and mechanical ventilation, and group S received a segmental (T10-11 injection) thoracic spinal anesthesia (through combined spinal epidural) using 1 ml of plain bupivacaine 0.5% (5 mg) in addition to 25 μg fentanyl. In group S, drugs to manage patient anxiety or hemodynamic perturbations (bradycardia or hypotension) were given when needed. Intraoperative monitoring, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two groups.ResultsAs regards the thoracic spinal group, spinal anesthetic was performed easily in all 20 patients, although two complained of paresthesia, which responded to slight needle withdrawal; the block was effective for surgery in all 20 patients, and five experienced some discomfort, which was readily treated with small doses of fentanyl, but none required conversion to general anesthesia; five patients required midazolam for anxiety, eight patients required ephedrine and atropine for hypotension and bradycardia, and recovery was uneventful and without sequelae.AimThe aim of this study is to compare discharge time, patient, and surgeon satisfaction between two groups of healthy patients submitted to laparoscopic cholecystectomy under general and segmental thoracic spinal anesthesia.ConclusionPatients received segmental thoracic spinal anesthesia had shorter discharge time and better satisfaction. Surgeon satisfaction was higher in general anesthesia group. Segmental thoracic spinal anesthesia can be used successfully and effectively for laparoscopic cholecystectomy in healthy patients by experienced anesthetists.