Laparoscopic Cholecystectomy Under Spinal Anesthesia: A Feasibility Study

Abstract

Laparoscopic cholecystectomy has traditionally been performed under general anesthesia. In spite of the emerging evidence it can be performed safely under regional anaesthesia. It has not gained widespread acceptance.ObjectivesGenerally, spinal anesthesia has lower postoperative mortality and fewer complications than general anesthesia, so it seems more suitable for the laparoscopic surgery. We designed a prospective observational study to determine the feasibility of spinal anesthesia for laparoscopic cholecystectomy as a routine in clinical practice.MethodsA total of 164 patients planned to undergo elective laparoscopic cholecystectomy for cholecystitis, with inclusion criteria of ASA grade I or II and ages 18–60 years were included in this study. Subarachnoid block was performed at the level of L2-L3 interspace with 0.5% hyperbaric Bupivacaine. After placement of the subarachnoid block, all patients were placed in a 20°–30° Trendelenburg position until the level of sensory anesthesia reached the T4 dermatome level. CO2 insufflation was started using pressure limit of 12 mmHg. Oxygen was given via face mask at 4 liters /minute. Heart rate, blood pressure, and spO2 were recorded every 3 minutes. During the procedure, anxiety was treated with 2 mg Midazolam and pain with 50 μg intravenous boluses of Fentanyl. Bradycardia was treated with 0.3-0.6 mg of intravenous Atropine. Continuous monitoring of hemodynamic parameters was done using noninvasive multiparameter monitor. Duration of anaesthesia, operative time, and duration of pneumoperitoneum were recorded. Postoperative pain, drug consumption, shoulder pain, anxiety, headache, nausea, vomiting, and abdominal discomfort were also recorded.ResultsLaparoscopic cholecystectomy is feasible and safe under spinal anaesthesia, and it can be recommended as anaesthesia of choice for conducting laparoscopic cholecystectomy in hospital setups of developing countries. Laparoscopic cholecystectomy has traditionally been performed under general anesthesia. In spite of the emerging evidence it can be performed safely under regional anaesthesia. It has not gained widespread acceptance. ObjectivesGenerally, spinal anesthesia has lower postoperative mortality and fewer complications than general anesthesia, so it seems more suitable for the laparoscopic surgery. We designed a prospective observational study to determine the feasibility of spinal anesthesia for laparoscopic cholecystectomy as a routine in clinical practice. Generally, spinal anesthesia has lower postoperative mortality and fewer complications than general anesthesia, so it seems more suitable for the laparoscopic surgery. We designed a prospective observational study to determine the feasibility of spinal anesthesia for laparoscopic cholecystectomy as a routine in clinical practice. MethodsA total of 164 patients planned to undergo elective laparoscopic cholecystectomy for cholecystitis, with inclusion criteria of ASA grade I or II and ages 18–60 years were included in this study. Subarachnoid block was performed at the level of L2-L3 interspace with 0.5% hyperbaric Bupivacaine. After placement of the subarachnoid block, all patients were placed in a 20°–30° Trendelenburg position until the level of sensory anesthesia reached the T4 dermatome level. CO2 insufflation was started using pressure limit of 12 mmHg. Oxygen was given via face mask at 4 liters /minute. Heart rate, blood pressure, and spO2 were recorded every 3 minutes. During the procedure, anxiety was treated with 2 mg Midazolam and pain with 50 μg intravenous boluses of Fentanyl. Bradycardia was treated with 0.3-0.6 mg of intravenous Atropine. Continuous monitoring of hemodynamic parameters was done using noninvasive multiparameter monitor. Duration of anaesthesia, operative time, and duration of pneumoperitoneum were recorded. Postoperative pain, drug consumption, shoulder pain, anxiety, headache, nausea, vomiting, and abdominal discomfort were also recorded. A total of 164 patients planned to undergo elective laparoscopic cholecystectomy for cholecystitis, with inclusion criteria of ASA grade I or II and ages 18–60 years were included in this study. Subarachnoid block was performed at the level of L2-L3 interspace with 0.5% hyperbaric Bupivacaine. After placement of the subarachnoid block, all patients were placed in a 20°–30° Trendelenburg position until the level of sensory anesthesia reached the T4 dermatome level. CO2 insufflation was started using pressure limit of 12 mmHg. Oxygen was given via face mask at 4 liters /minute. Heart rate, blood pressure, and spO2 were recorded every 3 minutes. During the procedure, anxiety was treated with 2 mg Midazolam and pain with 50 μg intravenous boluses of Fentanyl. Bradycardia was treated with 0.3-0.6 mg of intravenous Atropine. Continuous monitoring of hemodynamic parameters was done using noninvasive multiparameter monitor. Duration of anaesthesia, operative time, and duration of pneumoperitoneum were recorded. Postoperative pain, drug consumption, shoulder pain, anxiety, headache, nausea, vomiting, and abdominal discomfort were also recorded. ResultsLaparoscopic cholecystectomy is feasible and safe under spinal anaesthesia, and it can be recommended as anaesthesia of choice for conducting laparoscopic cholecystectomy in hospital setups of developing countries. Laparoscopic cholecystectomy is feasible and safe under spinal anaesthesia, and it can be recommended as anaesthesia of choice for conducting laparoscopic cholecystectomy in hospital setups of developing countries.