A study of laparoscopic cholecystectomy using spinal anaesthesia
Keywords:Laparoscopic cholecystectomy, General anaesthesia, Spinal anaesthesia, Ketamine, Diclofenac
Background: General anaesthesia (GA) is the anaesthetic technique of choice for laparoscopic cholecystectomy (LC). The main reasons for selecting spinal anaesthesia (SA) as the first choice for laparoscopic cases were its advantages like total muscle relaxation, a conscious patient, economical, relatively uneventful recovery after, pain free early postoperative period and the protection from potential complications of general anaesthesia.
Methods: It is a retrospective study conducted between June 2006 and July 2009. Patients undergoing laparoscopic abdominal procedures were offered SA as the first choice was included in this study. Out of 134 patients in study group 29 patients had acute cholecystitis and 105 underwent elective cholecystectomy were included. Patients who preferred general anesthesia or had contraindications for SA, like children less than 10 years of age, spinal deformity, cardiac problems and skin pathology overlying the SA site, were operated on while under general anesthesia and kept as controls.
Results: Out of 134 patients, 103 patients were females, average age was 41.8 years. LC was performed in all patients, 26 of had acute cholecystitis. 28 (20.89%) patients HAD hypotension, 32 (23.88%) observed anxiety, neck or shoulder pain, for which injection Ketamine had given and 1 (0.74%) patient required conversion because of anxiety, despite sedation where as one patient required conversion to general anaesthesia due to failure of SA effect. Laparoscopic cholecystectomy required an average of 28.4 minutes and 41.1 minutes, respectively, in elective and emergency settings. 5.9% (8) patients experienced more than vomiting episodes compared to 33% those under general anaesthesia. Injectable diclofenac was given in 49 (36.56%) of patients for their abdominal pain within 2 hours postoperatively and an oral analgesic was required in 106 (79.10%) patients within the first 24 hours postoperatively compared with 91.3 (91.3%) patients requiring injectable analgesia in the general anaesthesia group of patients. Average time to discharge was 1.9 days.
Conclusions: Laparoscopic surgery done with the patient under spinal anaesthesia has several advantages general anaesthesia. Laparoscopic cholecystectomy using spinal anaesthesia is a better alternative as there is no intubation related airway obstruction. There was excellent muscle relaxation; decreased surgical bed oozing, economical, pain free early post-operative period. A little risk of unrecognised hypoglycaemia was observed in a diabetic patient.
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