Safety and Feasibility of SAB in Otherwise Healthy Individuals Undergoing Laparoscopic Cholecystectomy

Abstract

Background: The safety and feasibility of utilizing SAB as the sole anesthetic technique in otherwise healthy individuals undergoing laparoscopic cholecystectomy have been increasingly recognized. SAB offers potential advantages in terms of reduced complications, improved pain control, and avoidance of general anesthesia-related risks. Objective: To assess safety and feasibility of SAB in otherwise healthy individuals undergoing laparoscopic cholecystectomy. Method: The study included a cohort of 40 patients who underwent elective laparoscopic cholecystectomy and met specific inclusion criteria. All patients received a subarachnoid block (SAB) with 3 ml of 0.5% bupivacaine and 25 micrograms of fentanyl at the L2-L3 level. The laparoscopic cholecystectomy procedure was performed using a standard 4-port technique, while maintaining a low intra-abdominal pressure of 9-10 mm Hg through CO2 pneumoperitoneum. The patients were followed up at various time points, including 30 minutes, 4 hours, the time of discharge, and on the 7th day after the operation. Any voluntary or involuntary movements or exaggerated diaphragmatic excursions during the operation were carefully monitored. The study recorded parameters such as operation time, duration of operating room occupancy, length of hospital stay, post-operative pain levels, analgesic requirements, occurrences of nausea, vomiting, headache, right shoulder pain, wound-related complications, and patient satisfaction. Results: SAB demonstrated efficacy in all 40 patients undergoing surgery. Conversion to general anesthesia was required in two cases due to persisting low oxygen saturation. Hypotension occurred in 23.7% of patients, while 10.5% experienced right shoulder pain. The average operating time was 37.3 minutes, ranging from 21 to 77 minutes. Awkward movements and exaggerated respiratory excursions were observed in 23.7% and 18.4% of cases, respectively. Only two cases required conversion to general anesthesia. The mean hospital stay duration was 29.3 hours. No major complications were reported during the study. Conclusion: These findings suggest that SAB can be successfully and effectively used for laparoscopic cholecystectomy in healthy patients, providing a safe alternative to general anesthesia.