SPINAL ANAESTHESIA VS GENERAL ANAESTHESIA IN SCOPIC UROSURGERY

Sabah Khudher Asfoor; Talal Abdulrazaq Shaker Shnayien; Ahmed Jabbar Kadhim

Sabah Khudher Asfoor Anesthesia and intensive care specialist, Al-Hussein teaching hospital, Samawah, Al-Muthanna, Iraq
Talal Abdulrazaq Shaker Shnayien Anesthesia and intensive care specialist, AlDiwaniyah teaching hospital, Aldiwanyia health directorate, Iraq
Ahmed Jabbar Kadhim Anesthesia and intensive care specialist, Imam Al _Sadiq teaching hospital, Babylon, Iraq

Keywords: spinal, general, anesthesia

Abstract

Spinal anaesthesia (SA) has shown promise as a safe substitute to general anesthesia (GA), which is the standard method for performing laparoscopic cholecystectomy (LC)[2]. This research set out to evaluate the relative merits of general anesthesia vs spinal anesthesia for the purpose of facilitating laparoscopic cholecystectomy. Using low tension pneumoperitonium with CO2 and 60 patients slated for elective laparoscopic cholecystectomy (LC) procedures, the research compared the effects of general anesthesia (GA) and spinal anesthesia (SA). Each group included of 25 patients. We used propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation in our general anesthesia case (n=25). To reach a sensory level of T3, 25 patients undergoing spinal anesthesia were given 15 mg of hyperbaric bupivacaine and 20 µg of fentanyl. Cost, surgical discomfort, complications, recovery, patient satisfaction, and intraoperative hemodynamic parameters were compared between the two groups. Two groups of patients were randomly assigned to undergo anaesthesia induction; twenty five individuals had spinal anesthesia and twenty five underwent general anesthesia. At2,4, and 6 hours post-procedure, patients in the spinal anesthesia group reported far less pain than those in the general anesthesia group. Comparing the two methods, spinal anesthesia was far less expensive than general anesthesia. Within one day, all patients were cleared for release.

In conclusion, spinal anesthesia is the preferred method of anesthesia for laparoscopic cholecystectomy since it is safe, practical, and does not need any changes to the technique. Additionally, it offers many benefits over general anesthesia.

References

1. Gutt CN, Oniu T, Mehrabi A, Schemmer P, Kashfi A, Kraus T, et al. Circulatory and respiratory complications of carbon dioxide insufflation. Dig Surg. 2004;21(2):95–105.
2. Hirvonen EA, Poikolainen EO, Pääkkönen ME, Nuutinen LS. The adverse hemodynamic effects of anesthesia, head-up tilt, and carbon dioxide pneumoperitoneum during laparoscopic cholecystectomy. Surg Endosc. 2000 Mar;14(3):272–7.
3. Kalaivani.V.et al. Laparoscopic Cholecystectomy Under Spinal Anaesthesia vs. General Anaesthesia: A Prospective Randomised Study -PMC [Internet]. [cited 2023 Jan 17]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4190755/
4. Sinha R, Gurwara AK, Gupta SC. Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):323–7.
5. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Laparoscopic cholecystectomy under spinal anesthesia: a pilot study. Surg Endosc. 2006 Apr;20(4):580–2.
6. Bessa SS, Katri KM, Abdel-Salam WN, El-Kayal ESA, Tawfik TA. Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study. J Laparoendosc Adv Surg Tech A. 2012;22(6):550–5.
7. Hamad MA, El-Khattary OAI. Laparoscopic cholecystectomy under spinal anesthesia with nitrous oxide pneumoperitoneum: a feasibility study. Surg Endosc. 2003 Sep;17(9):1426–8.
8. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal vs general anesthesia for laparoscopic cholecystectomy: interim analysis of a controlled randomized trial. Arch Surg Chic Ill 1960. 2008 May;143(5):497–501.
9. Mehta PJ, Chavda HR, Wadhwana AP, Porecha MM. Comparative analysis of spinal versus general anesthesia for laparoscopic cholecystectomy: A controlled, prospective, randomized trial. Anesth Essays Res. 2010;4(2):91–5.
10. Yuksek YN, Akat AZ, Gozalan U, Daglar G, Pala Y, Canturk M, et al. Laparoscopic cholecystectomy under spinal anesthesia. Am J Surg. 2008 Apr;195(4):533–6.
11. Postherniorrhaphy Urinary Retention—Effect of Local, Regional, and General Anesthesia: A Review | Regional Anesthesia & Pain Medicine [Internet]. [cited 2023 Jan 18]. Available from: https://rapm.bmj.com/content/27/6/612.share
12. Luiz Eduarddo Imbelloni, TSA1, Fornasari M2 , J C Fialho3, R S Anna4,J A Cordeiro5.”General Anesthesia versus Spinal Anesthesiafor Laparoscopic Cholecystectomy.” Rev Bras Anestesiol 2010;60: 3: 217-227.
13. Gan Yu1 , Qin Wen2, Li Qiu1, Li Bo1, Jiang Yu1. “Laparoscopic cholecystectomy under spinal anaesthesia vs. General anaesthesia: a meta-analysis of randomized controlled trials.” BMC Anesthesiology(2015) 15:176.
14. Mehta PJ1, Chavda HR1, Wadhwana AP1, Porecha MM2. Comparative Analysis of Spinal versus General anesthesia for Laparoscopic Cholecystectomy: A controlled, prospective, randomized trial. Anesth Essays Res. 2010 Jul-Dec;4(2):91-95.
15. Rajeev Sinha1, A K Gurwara, S C Gupta, Laparoscopic cholecystectomy under spinal anesthesia: a study of 3492 patients. J Laparoendosc Adv Surg Tech A. 2009 Jun;19(3):323-7.
16. Samer S Bessa1, Khaled M Khatri, Wael N Abdel-Salam, El-Saed A El-Kayal, Tarek A Tawfik,Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study. J Laparoendosc Adv Surg Tech A. Jul-Aug 2012;22(6):550-5.
17. Lennox PH, Vaghadia H, Henderson C, Martin L, Mitchell GW. Small-dose selective spinal anesthesia for short-duration outpatient laparoscopy: Recovery characteristics compared with desflurane anesthesia. Anesth Analg 2002,94(2):346-50