Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose...

Area of Science:

• Anesthesiology
• Surgical Innovation
• Pain Management

Background:

• Laparoscopic cholecystectomy is the preferred treatment for gallstones due to reduced pain and shorter hospital stays.
• Spinal anesthesia is an alternative to general anesthesia for this procedure.
• This study compares conventional versus low-dose spinal anesthesia for laparoscopic cholecystectomy.

Purpose of the Study:

• To compare the efficacy and safety of conventional-dose lumbar spinal anesthesia versus low-dose thoracic spinal anesthesia using hyperbaric bupivacaine and fentanyl for laparoscopic cholecystectomy.
• To evaluate intraoperative parameters, postoperative pain, recovery time, and patient satisfaction.
• To assess the incidence of hypotension and the need for general anesthesia conversion.

Main Methods:

• 140 patients with gallstones were randomized to receive either conventional lumbar spinal anesthesia (15 mg bupivacaine, 20 mg fentanyl) or low-dose thoracic spinal anesthesia (7.5 mg bupivacaine, 20 μg fentanyl).
• Procedures were performed under low-pressure CO2 pneumoperitoneum.
• Outcomes measured included block characteristics, pain scores, recovery metrics, and patient satisfaction.

Main Results:

• All surgeries were completed successfully under spinal anesthesia without conversion to general anesthesia.
• Low-dose bupivacaine resulted in significantly shorter block duration and fewer hypotensive events.
• Postoperative pain was higher at 6 and 12 hours with the low-dose regimen, but all patients were discharged within 24 hours.
• Patient satisfaction was high at 1-week follow-up.

Conclusions:

• Spinal anesthesia is a viable option for laparoscopic cholecystectomy.
• Low-dose hyperbaric bupivacaine (7.5 mg) with fentanyl (20 μg) provides adequate anesthesia with significantly less hypotension compared to conventional doses (15 mg bupivacaine).
• The low-dose strategy may enhance patient recovery and facilitate earlier discharge, particularly for ambulatory surgery.