Comparison of General Anesthesia with Spinal Anesthesia in Laparoscopic Cholecystectomy Operations


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Kısa A., Koruk S. , Koçoğlu H. , Leblebici İ. M.

Medeniyet Medical Journal, cilt.34, no.3, ss.346-353, 2019 (Hakemli Üniversite Dergisi)

  • Cilt numarası: 34 Konu: 4
  • Basım Tarihi: 2019
  • Doi Numarası: 10.5222/mmj.2019.37929
  • Dergi Adı: Medeniyet Medical Journal
  • Sayfa Sayısı: ss.346-353

Özet

OBJECTIVE
Spinal anesthesia (SA) in laparoscopic cholecystectomy (LC) operations still needs to be investigated since. We aimed to compare SA with general anesthesia (GA) in terms of efficacy and complications in LC operations, and to investigate the effects of preemptive analgesia on shoulder pain development, transition to general anesthesia, and postoperative analgesia.
MATERIALS and METHODS
Sixty patients in ASA I-II risk group between 18-65 years of age undergoing laparoscopic cholecystectomy were randomly divided into two groups as GA (n=30) and SA ( n=30). Patients were premedicated with i.v. midazolam and fentanyl preoperatively. Anesthesia was induced with propofol in GA group, and maintained with sevoflurane and remifentanil. In the SA group, spinal anesthesia was provided with 15 mg bupivacaine at L4-5 level, and block level was increased to T4 by keeping the patient in Trendelenburg position for 7-10 minutes. Demographic data, hemodynamic parameters, operation time, visual analog scale (VAS) scores at postoperative 0th,1st, 4th,8th,12th and 24th hour, patient-surgeon satisfaction, side effects, and occurrence of right shoulder pain in SA group were recorded.
RESULTS
Effective anesthesia was produced in both groups. The rate of hypotension and bradycardia was higher in Group SA. Nine patients developed perioperative shoulder pain, but none of them required general anesthesia. The postoperative VAS scores were significantly lower in Group SA at 0th,1st, 4th hours. Patient satisfection score was higher in Group SA.
CONCLUSION: We concluded that spinal anesthesia may be an alternative method to general anesthesia in laparoscopic cholecystectomy operations especially when the risk of general anesthesia is too high.

Keywords: Laparoscopic cholecystectomy, general anesthesia, spinal anesthesia, surgeon satisfaction, postoperative pain