EPIDURAL ANAESTHESIA;

Abstract

Objective: To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamicchanges and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epiduralanaesthesia. Study design: Quasi experimental study. Place and duration of study: Combined Military Hospital Rawalpindi from 15 October2007 to 15 April 2008. Methodology: American Society of Anaesthesiology (ASA) physical status (PS) I and II patient of either genderundergoing un-complicated open cholecystectomy were randomly divided into two groups, group A (n=30) received general anaesthesia (GA)and group B (n=29) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for peri-operative haemodynamicchanges, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups andobtain P-value. P-value of less than 0.05 was considered significant. Results: 9 out of 30 patients (30%) of group “A” (general anaesthesia) and4 out of 29 patients (13.79%) in group “B” (epidural anaesthesia) had vomiting. Shivering was seen in 3 out of 30 (10%) in group “A” (generalanaesthesia) and 1 out of 29 (3.44%) patient in group “B” (epidural anaesthesia). Urinary retention was seen in 1 out of 30 (3.33%) in group “A”(general anaesthesia) and 8 out of 29 (27.5%) in group “B” (epidural anaesthesia). Urinary retention was relieved by psychotherapy. None ofthe patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility (passage of flatus andstart of oral sips). In group “A” (general anaesthesia) 6 patients (20%) started oral sips in first post operative day, 16 patients (53.33%) onsecond post operative day, 8 patients (26.66%) in third post operative day. In the group “B” (epidural anaesthesia) 13 patients (44.8%) startedoral sips on first post operative day, 15 (51.72%) on second post operative day and one patient (3.44%) on third post operative day. Regardingthe length of hospital stay 17 patient (56.66%) of group “A” (general anaesthesia) were discharge by third post operative day and 22 patient(75.77) were discharge by third post operative day in group “B” (epidural anaesthesia). Conclusions: The use of intra-operative epiduralanaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomitingin patients under going open cholecystectomy.