Role of spinal anaesthesia and general anaesthesia during laparoscopic cholecystectomy
Combining minimal invasive surgical and lesser invasive anesthesia technique reduces morbidity and mortality. The aim of the study is to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy. The study was done in Shantiram medical college and general hospital, nandyal. 50 healthy patients were randomized under spinal anesthesia (n=25) & General Anesthesia (n=25). Hyperbaric 3ml bupivacaine plus 25mcg fentanyl was administered for spinal group and conventional general anesthesia for GA group. Intraoperative parameters and post-operative pain and recovery were noted. Under spinal group any intraoperative discomfort were taken care by reassurance, drugs or converted to GA. Questionnaire forms were provided for patients and surgeons to comment about the operation. None of the patients had significant hemodynamic and respiratory disturbance except for transient hypotension and bradycardia. Operative time was comparable. 4 patients under spinal anesthesia had right shoulder pain, 1 patients were converted to GA and 3 patients were managed by injection midazolam and infiltration of lignocaine over the diaphragm. There was significant post-operative pain relief in spinal group. All the patients were comfortable and surgeons satisfied. Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery, but require cooperative patient, skilled surgeon, a gentle surgical technique and an enthusiastic anesthesiologist.
Full Text Attachment