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Major laparoscopic surgery under regional anesthesia: A prospective feasibility study.
R K Singh1, A M Saini2, Nitin Goel3
1Senior Adviser (Anaesthesiology), Military Hospital Jaipur, Rajasthan, India.
Medical Journal, Armed Forces India
|April 11, 2015
Summary
Major laparoscopic surgeries like cholecystectomy and hysterectomy are feasible and safe under combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum. Postoperative shoulder pain was minimal with this approach.
Area of Science:
- Anesthesiology
- Minimally Invasive Surgery
Background:
- Laparoscopic surgery is the standard for abdominal conditions.
- Regional anesthesia offers an alternative to general anesthesia.
- Combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum is explored for major laparoscopic procedures.
Purpose of the Study:
- To assess the feasibility and safety of major laparoscopic surgeries (LC, LAVH/TLH) under CSE.
- To evaluate the efficacy of intrathecal fentanyl and bupivacaine with normal pressure pneumoperitoneum.
Main Methods:
- Prospective study of 50 patients undergoing LC or LAVH/TLH.
- Normal pressure (12 mmHg) pneumoperitoneum.
- CSE using intrathecal fentanyl (20 μg) and bupivacaine (0.5%), with plain bupivacaine (0.5%) for epidural anesthesia.
Main Results:
- Successful surgery in 48 patients (96%).
- Two cases converted to general anesthesia due to shoulder pain.
- Minor complications included urinary retention (5 patients) and pruritis (1 patient).
- No respiratory depression, aspiration, or headache observed.
Conclusions:
- Major laparoscopic surgeries are feasible and safe under CSE with normal pressure pneumoperitoneum.
- Intrathecal fentanyl effectively minimized postoperative shoulder pain.
- Complications were infrequent and manageable.
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