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

Sunder Goyal, Snigdha Goyal, Sham Singla.

Abstract
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 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 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.

Key words: General anesthesia, gall stone disease, laparoscopic cholecystectomy, spinal anesthesia



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