Minimally Invasive Anesthesia for Minimally Invasive Surgery: A Prospective Cohort Study

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<h3>Study Objective</h3> In the minimally invasive era, laparoscopic gynecological surgery is currently performed under general anesthesia (GA), which although considered a safe technique, is accountable for different adverse effects and delayed recovery. Regional anesthesia (RA) from an anesthesiology perspective could be considered the "minimally invasive technique". Aim of this study was to assess the feasibility and the perioperative outcomes of laparoscopic gynecological surgery in regional anesthesia from the point of view of the surgeon, anesthesiologist and patient. <h3>Design</h3> Prospective cohort study. <h3>Setting</h3> Tertiary care University of Naples Federico II. <h3>Patients or Participants</h3> 90 women (class I ASA, BMI <30) who were planned to undergo gynecologic laparoscopy surgery for benign pathology. All women were enrolled from March 2020 to April 2021. <h3>Interventions</h3> All patients underwent surgical laparoscopy under regional (Group A) or general anesthesia (Group B). Postoperative surgical and anesthesiological variables were recorded. Intraoperatively pain score on a Likert scale during all the stages of laparoscopy in RA was assessed. <h3>Measurements and Main Results</h3> Duration of surgery were comparable between the two groups and no conversion to general anesthesia was required. Postoperative pain was significantly lower in Group A up to 6 h (p< 0.005) with no statistically significant differences between the two groups at 24 h. The procedure was very acceptable from the patients. In all steps a maximum of 2 points on the Likert scale was recorded. A faster resumption of bowel motility (p <0.001) and patient's mobilization (<0.001) was observed in the group A as well as a lower incidence of post-operative nausea and vomit. Early discharge and greater patient's satisfaction were recorded in patients who underwent RA. <h3>Conclusion</h3> RA showed to decrease the impact of surgical stress and to guarantee a quicker recovery without compromising surgical results. As well as different surgical approaches can be selected to treat different pathologies, RA technique could be a viable option for patients.