To Compare Isobaric Thoracic Spinal Anesthesia Versus General Anesthesia in Laparascopy Cholecystectomy

Abstract

Background: The laparoscopic cholecystectomy procedure is typically carried out under general anesthesia, but regional techniques, such as low thoracic isobaric spinal anesthesia, have been used to manage patients with significant medical problem like coexisting systemic disease, who are deemed to be high risk in general anesthesia. Segmental spinal anesthesia has great outcomes in terms of post-operative discomfort, the need for analgesics, relatively fewer complications, and shorter hospital stays. Thus the aim of this study to avoid and minimize the risk of general anesthesia who does not have any significant comorbidity. So it might be a substitute for a standard laparoscopic cholecystectomy. Material and Methods: Total 60 adult patient with ASA1 & I I, 18-60 years, with normal coagulation profile, is divided into 2 groups. Group IS (Isobaric) - given 2.5 ml of isobaric preservative free bupivacaine 0.5% (levobupivacaine) + 0.5 mg of Fentanyl at T9-T10/T10-T11 into sub arachnoid space. Group GA – given general anesthesia using propofol, fentanyl citrate and atracurium besylate. After intubation, ventilation was controlled and balanced anesthesia was continued with isoflurane. After completion, neuromuscular block was anatagonized neostigmine methylsulfate and glycopyrrolate at the end of surgery. Results: Isobaric spinal anesthesia showed good control in intraoperative as well as postoperative pain control as compared to general anesthesia. In few patients, there were minor degrees of nausea, vomiting, abdominal pain, shoulder pain, patient anxiety or itchng which were treated with standard medication like fentanyl and midazolam. All patients can resume oral intake on the day of surgery. Conclusions: In conclusion, this study provide evidence that segmental spinal anesthesia can be used in place of general anesthesia in healthy individuals also.