Laparoscopic appendicectomy under spinal anaesthesia

Abstract

Nowadays laparoscopic appendicectomy ( LA ) is gaining popularity due to its certain benefits over the open technique. General anesthesia with positive pressure ventilation is the preferred mode of anesthesia in this technique. There are limited data about LA under spinal anesthesia. This study was designed to evaluate LA under spinal anesthesia for uncomplicated appendicitis . In this prospective study, 35 consecutive patients of ASA grade I or II, with a mean age of 22.5 years and mean BMI of 18.35 kg/m 2 , suffering from acute appendicitis, were included. All patients were informed about spinal anesthesia in detail. The patients were informed about the risk of conversion to general anesthesia, and all patients provided informed consent. Standard laparoscopic technique was applied to all patients. Simple questionnaire forms were developed for patients to provide comments about the operation. All the patients received ondansetron, diazepam, and pentazocine as premedication. Monitored anesthesia care was given. The operation was completed laparoscopically on 33 patients, while 2 patients were converted for open technique. None of the patients developed cardiopulmonary problems other than transient hypotension.. None of the patients required conversion to general anaesthesia.Seventeen patients developed mild right shoulder . Intravenous tramadol hudrochloride (10 mg) was needed in 16 patients due to severe right shoulder pain. Five patients complained about postural headache in postoperative period . Mean operative time was 25.35 minutes. In post operative period median pain score at 4 hr was 1.5 (range, 0-5), at 8 hr it was 1 (range, 0-6), and at 24 hr it was 1 (range, 0-4). No one patient developed wound infection or any other complication. All thirty three patients were discharged after 24 hr. All of the patients' answers to the questions regarding the comfort of operation were well at the 1-month postoperative evaluation. Laparoscopic appendicectomy with low-pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and at least an equally good recovery as with general anesthesia.