Spinal Anesthesia for Laparoscopic Cholecystectomy:Is it a Feasible Alternative?

Background and Aims: Although mostly performed under general anesthesia, regional anesthesia has been sparingly employed in patients undergoing laparoscopic cholecystectomy. Recent evidence labels regional anesthetic techniques to be safe and highly acceptable for laparoscopic cholecystectomy. The present study was undertaken to evaluate and compare the effects of general or regional anaesthesia on haemodynamics, blood gases, postoperative pain and recovery scores, rescue analgesic consumption, and side effects in patients undergoing elective laparoscopic cholecystectomy. Methods: 80 patients were randomized in two groups of 40 each to receive either general or spinal anaesthesia for pain, hemodynamic variables, respiratory rate and cumulative rescue analgesic consumption. Intraoperative shoulder pain, oxygen saturation and arterial blood gas parameters were compared in both the groups. Intraoperative consumption of vasopressors was also observed. Modified Aldrete scoring was used to evaluate the recovery characteristics of both the techniques. Patient and surgeon feedback was assessed by the use of preformed questionnaire. At the end of study, data was compiled and analysed with appropriate statistical tests. Results: Spinal anaesthesia provided better postoperative analgesia in patients undergoing laparoscopic cholecystectomy as evident by lower VAS scores and lesser total analgesic consumption. There were more incidences of bradycardia, hypotension, and significant arterial blood gas changes under spinal anaesthesia. Patients in spinal anaesthesia group demonstrated better recovery score as well as lesser incidence of PONV IN PACU. Conclusion: Spinal anesthesia can be used as sole anesthetic technique in patients undergoing elective laparoscopic cholecystectomy especially in patients where general anesthesia carries its own inherent risks.