Spinal Anaesthesia for Quicker Recovery in Fast-Track Abdominal Hysterectomy

Abstract

Introduction: Fast-track approach during hysterectomy has revolutionized the postoperative recovery. In this study we tried to analyse the effect of one more component (spinal anaesthesia versus general anaesthesia) during hysterectomy for benign gynaecological conditions to further hasten the postoperative recovery and thus evolve the concept. Aim: To compare recovery among those who receive spinal anaesthesia versus those who receive general anaesthesia during fast tract abdominal hysterectomy. Materials and Methods: A total of 97 women were recruited who were planned for hysterectomy for benign conditions and agreed to follow the fast-track protocol. Forty six consented for spinal anaesthesia (three cases were excluded later) and 51 for general anaesthesia. Fast-track protocol was followed that included preoperative counselling, and no preoperative sedation. Postoperatively all patients were monitored for pain, vomiting, drowsiness and fatigue. Early oral intake and ambulation was encouraged. Postoperative events and complications as well as duration of hospital stay were compared among the two groups. Differences in continuous variables were analysed with student’s t-test for normally distributed data and the Mann-Whitney U Test for skewed data. Pain score was analysed by repeated measures of ANOVA. Results: Mean operating time in spinal anaesthesia group, was much less (92.72+23.61 minutes) than in general anaesthesia group (124.20+33.61 minutes), the difference being statistically significant (p<0.001). Mean blood loss was also less in spinal anaesthesia group (298.14+61.34 ml versus 404.90+110.57 ml; p<0.001). Women in this group could be started on oral fluids earlier, had less vomiting and fatigue postoperatively, and passed motion earlier. Duration of hospital stay was not found to be much different between the groups. However, patients who were in the spinal anaesthesia resumed their routine activities earlier (15.47+2.77 versus 18.55+4.25 days; p<0.001). We also noted an interesting finding yet undiscussed in the literature that general anaesthesia group had more than 2.5 times higher incidence of postoperative cough which has the potential to influence postoperative recovery following any abdominal surgery. Conclusion: Spinal anaesthesia should be considered in cases that are planned for hysterectomy under fast-track setting to optimise the results.