Abstract

LAPAROSCOPIC CHOLECYSTECTOMY UNDER THORACIC SPINAL ANESTHESIA. COMPARATIVE STUDY BETWEEN TWO DIFFERENT HYPERBARIC BUPIVACAINE DOSES

Luiz Eduardo Imbelloni* – MD, PhD, Marcos Fornasari – MD, José Carlos Fialho – MD, Raphael Sant’ Anna – MD and Geraldo Borges de Morais Filho, MSc, Geraldo Borges de Morais Alencar

ABSTRACT

Aims: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a prospective study with 200 patients undergoing laparoscopic cholecystectomy under thoracic spinal anesthesia with two low doses. Settings and Design: Prospective observational and comparative. Methods and Material: Informed consent was obtained from all patients, and the trial protocol was approved by the hospital medical ethics committee. Two hundred patients with symptoms of cholelithiasis, laparoscopic cholecystectomy were operated under spinal anesthesia with pneumoperitoneum and low pressure CO2. We compared 10 mg with 7.5 mg of hyperbaric bupivacaine with thoracic puncture, all with 20μg fentanyl until the sensory level reached T3. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction, were compared between both groups. Statistical analysis used ANOVA, Kruskal-Wallis test, Chi-square test, Fisher's exact test or Mann-Whitney test. Differences were considered significant when p ≤ 0.05. Results: All procedures were completed under spinal anesthesia. The use of lidocaine 1% was successful in the prevention of shoulder pain in 180 (80%) patients. There were significant differences in time to reach T3, obtaining 10 mg>7.5 mg. There is no a positive correlation between the dose and the incidence of hypotension. There was a positive correlation between the dose and duration of sensory and motor block. Sensory block was almost twice the motor block at all doses. With both low doses 62.5% of patients went from table to stretcher. Satisfaction occurred in 100% of patients. Conclusions: Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia with low-pressure pneumoperitoneum of CO2. Thoracic spinal anesthesia with low doses of hyperbaric bupivacaine provided sensory block of longer duration than motor block, hemodynamic stability, early ambulation and discharge with higher degree of patient satisfaction making it excellent for day case surgery.

Keywords: Cholecystectomy; Laparoscopic, Cholecystectomy; Laparoscopic, Spinal Anaesthesia.