Comparative Study of Segmental Thoracic Spinal Versus Thoracic Epidural Anesthesia for Laparoscopic Cholecystectomy

Abstract

Background: Laparoscopic cholecystectomy the standard surgery for gallstone disease have been successfully performed under regional anesthetic techniques.In our study we compared thoracic epidural anaesthesia versus segmental thoracic spinal anaesthesia in healthy patients regarding safety, efficacy and complication. Aim and objective: This study was designed to compare and evaluate safety, efficacy ,benefits and complications of conducting laparoscopic cholecystectomy under segmental thoracic spinal versus thoracic epidural anesthesia. Method: Seventy ASA I or II patients undergoing laparoscopic cholecystectomy were randomized into two groups, one group received segmental thoracic spinal anesthesia (TSA) T8-T9 level using 7.5 mg isobaric bupivacaine 0.5% and 25 μg fentanyl with total volume 2ml, other group received thoracic epidural anesthesia (TEA) T8-T9 10 ml of 0.5% isobaric bupivacaine and 25μg fentanyl. Results: Segmental thoracic spinal technique was less technical difficulty (p value 0.017), less shoulder pain (p value0.017 ) more abdominal relaxation ( p value 0.015) than epidural technique (two cases were converted to general anaesthesia in epidural group and one patient in spinal group duo to uncontrollable patient discomfort. The two blocks were effective for surgery with better patient and surgical satisfaction in spinal group recovery. Conclusion: Both segmental thoracic spinal and thoracic epidural anaethesia were safe and effective anaethetic technique for laparoscopic cholecystectomy with less technical difficulty and better abdominal relaxation in spinal group.