THORACIC SEGMENTAL SPINAL ANAESTHESIA/ GENERAL ANAESTHESIA FOR LAPROSCOPY SURGERY

Abstract

Background:Laparoscopic surgeries are usually done under general anesthesia, but many patients with major medical problems sometimes cannot tolerate such anesthesia, and thoracic spinal anesthesia may be beneficial in such patients. A comparative study between two groups of patients using either general anesthesia or segmental thoracic spinal anesthesia. Aim & objectives:The aim of this study is to compare mean hospital stay, patient, and surgeon satisfaction between two groups of healthy patients operated for various laparoscopic surgeries under general and segmental thoracic spinal anesthesia. Study period&place:December 2022-January2023 ( 1 month),in Narendra Modi Medical collage& L.G hospital,Ahmedabad. Patients and methods:Thirty adult patients of ASA I or II grade undergoing various laparoscopic surgeries, randomly divided into two groups of 15 patients each. Group G received conventional general anesthesia with endotracheal intubation and mechanical ventilation through Drager Fabious GS workstation.Group S received a segmental (T 7-8 inj.) thoracic spinal anesthesia using 1 .5ml of plain levobupivacaine 0.5% (7.5 mg) in addition to 25 μg fentanyl. In group G,after pneumoperitoneum for haemodynamic changes( hypertension,tachycardia) iv fentanyl alliquotes,increase sevoflurane concentration,needed.In cases not responding to them inj.Nitroglycerin infusion was given. In group S, drugs to manage patient anxiety or hemodynamic fluctuations (bradycardia or hypotension) were given when needed. Intraoperative haemodynamic monitoring, postoperative pain, complications, recovery time by modified alderte score>8 and patient & surgeon satisfaction,mean hospital stay were compared between the two groups. Results: In the GroupS, spinal anesthetia was performed easily in all 15 patients, although two complained of paresthesia, which respondedto slight needle withdrawal the block was effective for surgery in all patients, and five experienced some discomfort, shoulder pain which was readily treated with small doses of fentanyl, but none required conversion to general anesthesia five patients required midazolam for anxiety, six patients required mephentermine and atropine for hypotension and bradycardia, and recovery was uneventful and without sequelae. In group G,3(20%) patients required infusion of Nitroglycerin for hypertension& 5(33%) patient required 2 times fentonyl alliquotes of 50 mcg iv.,3(20%) patients required increase concentration of sevoflurane ( upto 5%) Conclusion: Patients of Thoracic segmental spinal anesthesia group had shorter discharge time( time to achieve modified alderte acore>8) and better patient satisfaction. Surgeon satisfaction was higher in general anesthesia group. Segmental thoracic spinal anesthesia can be used successfully and effectively for laparoscopic surgery.