A study of laparoscopic cholecystectomy using spinal anaesthesia


  • Tarun Agarwal Department of Surgery,Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Shahhid Akhtar Department of Anaesthesia, Career Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
  • Veenu Jain Department of Pathology, Integral University, Lucknow, Uttar Pradesh, India




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.


Casey WF. Spinal Anaesthesia –a practical guide. In update in Anaesthesia. 2000;12(8);1.

Sinha R, Gurwara AK, Gupta SC. Laparaoscopic surgery using spinal anaesthesia. JSLS. 2008;12(2):133-8.

Van Zundert AAJ, Stultients G, kakimowicz JJ, Peek D, van der Ham WGJM, Korsten HHM, et al. Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study. Br J Anaesth. 2007;98(5):682-6.

Tzovaras G, Fafoulakis F, Pratsas K, Georgopulou S, Hatzitheofilou C. Spinal versuss general anaesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial. Arch Surg. 2008;143(5):497-501.

Eldawlathy AA, Al-Dohayan A, Fadin A. Epidural anaesthesia for laparoscopic cholecystectomy. Patient with dilated cardiomyopathy case report and review of literature. The Internal Journal of Anaesthesia. 2007;13(1).

Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anaesthesia: a study of 3492 patients. Journal of Laparoendoscopic and Advanced Surgical Techniques. 2009;19(3):323-7.

Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc. 2006;20:580-2.

Pursnani KG, Bazza Y, Calleja M, Mughal MM. Laparoscopic cholecystectomy under epidural anesthesia in patients with chronic respiratory disease. Surg Endosc. 1998;12:1082-4.

Gramatica L, Brasesco OE, Luna MA, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anesthesia in patient with chronic obstructive pulmonary disease. Surg Endosc. 2002;163:472-5.

Hamad MA, Ibrahim El, Khattary OA. Laparoscopic cholecystectomy under spiral anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc. 2003;17:1426-8.

Ciofolo MJ, Clergue F, Seebacher J, Lefebvre G, Viars P. Ventilatory effects of laparoscopy under epidural anesthesia. Anesth Analg. 1990;70(4):357-61.

Chiu AW, Huang WJ, Chen KK, Chang LS. Laparoscopic ligation of bilateral spermatic varices under epidural anesthesia. Urol Int. 1996;57(2):80-4.

Bernd H, Axel J, Joachim K, Benson M, Jost A, Banzhaf A. The incidence and risk factors for hypotension after spinal anesthesia induction: an analysis with automated data collection. Anesth Analg. 2002;94:1521-9.

Palachewa K, Chau-In W, Naewthong P, Uppan K, Kamhom R. Complications of spinal anesthesia at Stinagarind Hospital. Thai J Anesth. 2001;27:1:7-12.

Throngnumchai R, Sanghirun D, Traluzxamee K, Chuntarakup P. Complication of spinal Anaesthsia at Lerdsin Hospital. Thai J Anesth. 1999;25:24-7.

Hyderally H. Complications of spinal anesthesia. Mt Sinai J Med. 2002;55-56.

Chui PT, Gin T, Oh TE. Anesthesia for laparoscopic general surgery. Anesth Intensive Care. 1993;21(2):163-71.

Casey WF. Spinal anaesthesia: a practical guide. Practical Procedures. 2000;12:1-7.

Putensen-Himmer G, Putensen CH, Lammer H, Haisjack IM. Comparison of postoperative lung function in patent undergoing laparotomy or laparoscopy for cholecystectomy. Am Rev Resp Dis. 1992;145:A156.

Nishio I, Noguchi J, Konishi M, Ochiai R, Takeda J, Fukushima K. The effects of anesthetic techniques and insufflating gases on ventilation during laparoscopy. In Japanese, Masui. 1993;42(6):862-6.

Rademaker BM, Ringers J, Odoom JA, de Wit LT, Kalkman CJ, Oosting J. Pulmonary function and stress response after laparoscopic cholecystectomy: comparison with subcostal incision and influence of thoracic epidural analgesia. Anesth Analg. 1992;75(3):381-5.

Ciofolo MJ, Clergue F, Seebacher J, Lefebvre G, Viars P. Ventilatory effects of laparoscopy under epidural anesthesia. Anesth Analg. 1990;70(4):357- 61.

Nathanson LK, Shimi S, Cuschieri A. Laparoscopic cholecystectomy: the Dundee technique. Brj surg. 1991:78:155-9.

Fielding GA. Laparoscopic cholecystectomy. Aust N Z J Surg. 1992;62:181-7.

Jayashree S, Kumra VP. Anesthesia for laparoscopic surgery. IJS. 2003;65:232-40.

Vaghadia H, McLeod DH, Mitchell GW, Merrick PM, Chilvers CR. Small dose hypobaric lidcaine -fentanyl spinal anesthesia for short duration outpatient laparoscopy. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg. 1997;84(1):59-64.

Malins AF, Field JM, Nesting PM, Cooper GM. Nausea and vomiting oral ondansetron metoclopraide and placebo. Br J Anaesth. 1994;72:231-3.






Original Research Articles