A CLINICAL COMPARATIVE STUDY BETWEEN GENERAL ANAESTHESIA AND SPINAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY IN ELECTIVE SUEGERIES.

Main Article Content

Dr Dipjyoti Shyam
Dr Mridupaban Nath
Dr Anupananda Choudhury

Keywords

Anaesthesia, General, Spinal, Laparoscopic

Abstract

Background and Objectives: Laparoscopic cholecystectomy(LC) is conventionally performed under general anaesthesia(GA), but there are studies which have found spinal anaesthesia(SA) as a safe alternative[2].   The objective of this study was to compare the ease of performing Laparoscopic Cholecystectomy under General Anaesthesia and Spinal Anaesthesia.


Material and Methods: The study was conducted in 60 patients who were candidate of elective surgeries for laparoscopic cholecystectomy(LC) with low tension pneumoperitonium with CO2 and divided into two random groups (30 in each group) of general anaesthesia(GA) and spinal anaesthesia(SA) In General Anaesthesia (n=30), Propofol, Fentanyl, Atracurium, Sevoflurane and Tracheal intubation were done. In Spinal Anaesthesia (n=30), Hyperbaric Bupivacaine 15 mg and fentanyl 20 µg to achieve a sensorial level of T3 were used[1]. Intraoperative hemodynamic parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between the two groups[1].


Results and Observation: Induction of anaesthesia were done between two randomly divided patients (n=30 for GA and n=30 for SA) and there were no conversion from spinal to general anaesthesia[3]. Pain was significantly lower at 2, 4, and 6 hours after the procedure for spinal anaesthesia group as compared to those who received general anaesthesia. The cost of the spinal anaesthesia was significantly lower than that of the general anaesthesia. All patients were discharged after 24 hours[1].


Conclusion: Laparoscopic cholecystectomy done under spinal anesthesia is safe and feasible and 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.

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References

1. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21(2):95–105.
2. Hirvonen EA, Poikolainen EO, Pääkkönen ME, Nuutinen LS. The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 2000 Mar;14(3):272–7.
3. Kalaivani.V.et al. Laparoscopic Cholecystectomy Under Spinal Anaesthesia vs. General Anaesthesia: A Prospective Randomised Study - PMC [Internet]. [cited 2023 Jan 17]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190755/
4. Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):323–7.
5. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc. 2006 Apr;20(4):580–2.
6. Bessa SS, Katri KM, Abdel-Salam WN, El-Kayal ESA, Tawfik TA. Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study. J Laparoendosc Adv Surg Tech A. 2012;22(6):550–5.
7. Hamad MA, El-Khattary OAI. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc. 2003 Sep;17(9):1426–8.
8. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial. Arch Surg Chic Ill 1960. 2008 May;143(5):497–501.
9. Mehta PJ, Chavda HR, Wadhwana AP, Porecha MM. Comparative analysis of spinal versus general anesthesia for laparoscopic cholecystectomy: A controlled, prospective, randomized trial. Anesth Essays Res. 2010;4(2):91–5.
10. Yuksek YN, Akat AZ, Gozalan U, Daglar G, Pala Y, Canturk M, et al. Laparoscopic cholecystectomy under spinal anesthesia. Am J Surg. 2008 Apr;195(4):533–6.
11. Postherniorrhaphy Urinary Retention—Effect of Local, Regional, and General Anesthesia: A Review | Regional Anesthesia & Pain Medicine [Internet]. [cited 2023 Jan 18]. Available from: https://rapm.bmj.com/content/27/6/612.share
12. Luiz Eduarddo Imbelloni, TSA1 , Fornasari M2 , J C Fialho3 , R S Anna4 ,J A Cordeiro5.” General Anesthesia versus Spinal Anesthesia for Laparoscopic Cholecystectomy.” Rev Bras Anestesiol 2010;60: 3: 217-227.
13. Gan Yu1 , Qin Wen2, Li Qiu1, Li Bo1, Jiang Yu1. “Laparoscopic cholecystectomy under spinal anaesthesia vs. General anaesthesia: a meta-analysis of randomized controlled trials.” BMC Anesthesiology(2015) 15:176.
14. Mehta PJ1, Chavda HR1 , Wadhwana AP1, Porecha MM2 . Comparative Analysis of Spinal versus General anesthesia for Laparoscopic Cholecystectomy: A controlled, prospective, randomized trial. Anesth Essays Res. 2010 Jul-Dec;4(2):91-95.
15. Rajeev Sinha1, A K Gurwara, S C Gupta, Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):323-7.
16. Samer S Bessa1, Khaled M Khatri, Wael N Abdel-Salam, El-Saed A El-Kayal, Tarek A Tawfik, Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study. J Laparoendosc Adv Surg Tech A. Jul-Aug 2012;22(6):550-5.
17. Lennox PH, Vaghadia H, Henderson C, Martin L, Mitchell GW. Small-dose selective spinal anesthesia for short-duration outpatient laparoscopy: Recovery characteristics compared with desflurane anesthesia. Anesth Analg 2002,94(2):346-50