Abstract
Background and Objectives: The main benefits of laparoscopic surgery in comparison to open surgery involve the rapid discharge from recovery room, decreased postoperative hospital stays, reduced postoperative discomfort, easier getting back to work and faster return to ordinary daily life as well as cosmetic surgical wounds. The anesthesia type has an essential role in attenuation of the surgical stress and achievement of these advantages. We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction (interleukin 6 and 8 levels), hemodynamic changes (BP, HR, RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II. They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018. They were randomly allocated into two groups. Group A (n. 20) received general anesthesia only and Group B (n. 20) received general anesthesia in conjunction with thoracic epidural analgesia using fentanyl and bupivacaine in the epidural catheter. Chi-square was applied to differentiate categorical variables, whereas comparison between continuous variables was done by using t-test. Two-tailed p ficant. Results: As regards IL-6 and IL-8 post-operative there is significant difference (p nd and 4th hr and 24th hr postoperative, with significantly increased postoperative levels of IL-6 and IL-8 in comparison to their preoperative baseline values. The largest increase in IL6 & IL8 levels was in group A (GA group). VAS score showed significant lower values in TEA group in comparison to GA group. No significant difference between groups as regard intraoperative and postoperative hemodynamic changes. Conclusion: Regional techniques including TEA attenuate and decrease cytokine reaction secondary to surgery which decreases inflammatory process and improves patient outcome and reduces pain score postoperatively.
Highlights
Laparoscopic cholecystectomy has considered as the typical operation for treatment of patients having cholecystitis indicated for surgical removal of gall bladder
We aimed to determine the outcome of giving general anesthesia in conjunction with thoracic epidural analgesia (TEA) compared to general anesthesia alone on stress response to surgery and anesthesia by investigating cytokine reaction, hemodynamic changes (BP, heart rate (HR), RR, SPO2), and Visual Analogue Scale (VAS) scores postoperatively in patients subjected for laparoscopic cholecystectomy
Group B (GA combined with TEA group): The same anesthesia technique like group A, except that thoracic epidural catheter was inserted and T6-level sensory block was confirmed before administration of GA as follows: With the patients in the sitting position, under complete aseptic technique, the skin over 8th - 9th thoracic interspace was infiltrated with 1% lidocaine
Summary
Laparoscopic cholecystectomy has considered as the typical operation for treatment of patients having cholecystitis indicated for surgical removal of gall bladder. This type of surgery has certain benefits including small incision, decreased loss of blood, less postoperative analgesic requirements, and decreased recovery time and hospitalization. Methods: This study included 40 patients aged 20 - 60 years old with American Society of Anesthesiologists physical status (ASA) I and II They were planned for laparoscopic cholecystectomy at Aswan University Hospital from April 2017 to March 2018.
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