General anesthesia versus spinal anesthesia in laparoscopic cholecystectomy: safety, feasibility, and affordability in rural hospital in India

Abstract

General anesthesia (GA) is the choice for laparoscopic cholecystectomy (LC). Spinal anesthesia (SA) is usually preferred in patients where GA is contraindicated. In this study, SA was used in 67 patients in whom LC was planned (study group). LC has been conventionally done under GA. Regional anesthesia is usually preferred in patients where GA is contraindicated. SA was used in 67 patients for LC (study group). Moreover, 50 patients were given GA as a control group. There was no modification in the technique, and the intra-abdominal pressure was kept at 8–10 mmHg. Sedation was given if required, and conversation to GA was done in patients not responding to sedation or with failure of SA. Of 67 patients, two patients required conversation to GA. Hypotension requiring support was recorded in 14 (20.89%) patients and 16 (23.88%) experienced neck or shoulder pain or both. Postoperatively, two (2.9%) patients had vomiting as compared 17 (34%) patients who were administered GA. Injectable diclofenac was required in 25 (37.3%) patients for abdominal pain within 2 h postoperatively and oral analgesic for 53 (79.10%) patients within the first 24 h in SA group. However, 96% of patients operated under GA required injectable analgesics in the immediate postoperative period. Postural headache was experienced by five (7.46%) patients postoperatively. The average time of discharge was 1.9 in patients operated under SA compared with 2.1 days in GA group. There is no risk of intubation-related airway obstruction, little risks of unrecognized hypoglycemia in a diabetic patient, excellent muscle relaxation, decreased surgical bed oozing, and a more rapid return of gut function when LC is done using SA compared with GA.