Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

Laparoscopic Cholecystectomy Under Spinal Anesthesia with Low-Pressure Pneumoperitoneum - Prospective Study of 150 Cases

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Objective of study: Laparoscopic cholecystectomy under general anesthesia has attained the status of a gold standard for uncomplicated symptomatic gall stone disease; we therefore performed this study to assess its feasibility under spinal anesthesia with low-pressure pneumoperitoneum.Lower pressures are claimed to be safe and effective in decreasing cardiopulmonary complications and pain.Materials and Methods: In a private rural medical college, 150 patients were selected prospectively for laparoscopic cholecystectomy, under low-pressure (8mmHg) pneumoperitoneum and under spinal anesthesia over a Training Reins span of one and a half years.

Injection bupivacaine (0.5%) was used for spinal anesthesia.All ports were made in a head-down position to avoid hypotension.

Shoulder pain was managed by reassurance as well as by diverting the attention and sedation in a few cases.Results: We successfully performed the operations in 145 patients without major complications.Spinal anesthesia was converted to general anesthesia in five patients Botanicals/Herbs due to severe shoulder pain.

Age varied between 21 and 75 years.Duration of operation time (skin to skin) was between 40 and 80 minutes.Twenty-nine patients complained of right shoulder pain.

Most of them were managed by reassurance from the anesthetist and a few needed an injection of fentanyl along with midazolam.Conclusion: Laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum is feasible and safe under spinal anesthesia.Incidence of postoperative shoulder pain and complications are comparable with laparoscopic cholecystectomy under general anesthesia.

[Arch Clin Exp Surg 2012; 1(4.000): 224-228].