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Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients
Rajeev Sinha1, A K Gurwara, S C Gupta
1Department of Surgery, MLB Medical College and Railway Hospital, Jhansi, India. sinha_rga@yahoo.co.in
Objectives:
Spinal anesthesia (SA) for laparoscopic cholecystectomy (LC) is only contemplated in patients where general anesthesia (GA) is contraindicated. In this paper, we present our experience of over 12 years of performing laparoscopic cholecystectomy, primarily under spinal anesthesia.
Methods:
Over the last 12 years, LC was done under SA in 3492 patients. There was no modifications in technique, as compared to the same procedure done under GA. The intra-abdominal pressure was kept at 8-10 mm Hg. Sedation was given, if required, and conversion to GA was done in patients not responding to sedation or with failure of SA. RESULTS were compared with those of 538 patients undergoing LC under GA.
Results:
Eighteen (0.52%) patients required a conversion to GA. Hypotension requiring support was recorded in 700 (20.05%) patients, and 429 (12.29%) patients experienced neck and/or shoulder pain. Overall, 2.29% (80) patients had vomiting in the postoperative period, as compared to 30.30% (163 patients) in patients administered GA. In total, 34.36% (1200) patients required injectable diclofenac for their abdominal pain within 2 hours postoperatively after SA, and oral analgesic was required in 2150 (61.57%) patients within the first 24 hours. On the other hand, 91.45% patients operated on under GA required injectable analgesics in the immediate postoperative period. Postural headache persisting for an average of 2.6 days was seen in 206 (5.9%) patients in the postoperative period after SA. There was no difference in operative parameters between the two groups, with 88.95% patients requiring only three ports under SA, as compared to 89.41% in the GA group. Operative time, too, was not much different. Postoperatively, biliary leak was seen in 0.60% patients, as compared to 0.93% in the GA group. Average time to discharge was almost similar in both the groups. Kernofsky's performance status showed a 98.6% satisfaction level in patients.
Conclusions:
LC done under spinal anesthesia does not require any change in technique and, at the same time, has a number of advantages, as compared to general anesthesia, and should be the anesthesia of choice.
