THORACIC EPIDURAL VERSUS GENERAL ANAESTHESIA FOR LAPAROSCOPIC CHOLECYSTECTOMY: A RANDOMIZED CONTROLLED TRIAL
AbstractBackground: Laparoscopic cholecystectomy is one of the most commonly performed surgeries worldwide. Aim of our study was to compare the effectiveness of thoracic epidural anaesthesia with general anaesthesia for Laparoscopic cholecystectomy in terms of changes in blood pressure during surgery, postoperative pain, respiratory complications and average length of hospital stay. It was a randomized controlled trial conducted from 1stOctober 2018 to 31st October 2019. Methods: Eighty-two patients planned to undergo elective laparoscopic cholecystectomy were randomly divided into two groups, T and G. In Group T all patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia with 12 ml of 0.25% bupivacaine and 1% lignocaine plain whereas in group G all patients underwent surgery under general anaesthesia. Intra-operative mean arterial pressure (MAP) and postoperative opioid consumption in first 24hrs were recorded as primary outcomes whereas presence or absence of respiratory complication and duration of hospital stay as secondary outcome. Results: Out of 82 patients, 41 patients underwent laparoscopic cholecystectomy under thoracic epidural anaesthesia and 41 patients had surgery under general anaesthesia. Mean arterial pressure was lower in Group T and the difference was statistically significant. The average time of first complaint of postoperative pain in Group T was 5.4±1.26 hours as compared to less than 0.79±0.25 hours in Group G. Patients in group T required lower doses of opioid analgesia in first twenty-four hours as compared to patients in group G. Mean hospital stay in group T was 1 day as compared to 3 days in group G. Conclusion: Thoracic epidural anaesthesia provides a better alternative to general anaesthesia for Laparoscopic cholecystectomy with lower intraoperative mean arterial blood pressure, 24 hours postoperative consumption of opioids, respiratory complications and length of hospital stay.
Alli VV, Yang J, Xu J, Bates AT, Pryor AD, Talamini MA, et al. Nineteen-year trends in incidence and indications for laparoscopic cholecystectomy: the NY State experience. Surg Endosc 2017;31(4):1651–8.
Strosberg DS, Nguyen MC, Muscarella P, Narula VK. A retrospective comparison of robotic cholecystectomy versus laparoscopic cholecystectomy: operative outcomes and cost analysis. Surg Endosc 2017;31(3):1436–41.
Csikesz NG, Singla A, Murphy MM, Tseng JF, Shah SA. Surgeon volume metrics in laparoscopic cholecystectomy. Dig Dis Sci 2010;55(8):2398–2405.
Brauer DG, Hawkins WG, Strasberg SM, Brunt LM, Jaques DP, Mercurio NR, et al. Cost variation in a laparoscopic cholecystectomy and the association with outcomes across a single health system: Implications for standardization and improved resource utilization. HPB (Oxford) 2015;17(12):1113–8.
Shaffer EA. Epidemiology and risk factors for gallstone disease: has the paradigm changed in the 21st century? Curr Gastroenterol Rep 2005;7(2):132–40.
Song Z, Safran DG, Landon BE, Landrum MB, He Y, Mechanic RE, et al. The 'alternative quality contract,' based on a global budget, lowered medical spending and improved quality. Health Aff (Millwood) 2012;31(8):1885–94.
Kapoor T, Wrenn SM, Callas PW, Abu-Jaish W. Cost Analysis and Supply Utilization of Laparoscopic Cholecystectomy. Minim Invasive Surg 2018;2018:7838103.
Das W, Bhattacharya S, Ghosh S, Saha S, Mallik S, Pal S. Comparison between general anaesthesia and spinal anaesthesia in attenuation of stress response in laparoscopic cholecystectomy: a randomized prospective trial. Saudi J Anaesth 2015;9(2):184–8.
Gramatica L Jr, Brasesco OE, Mercado Luna A, Martinessi V, Panebianco G, Labaque F, et al. Laparoscopic cholecystectomy performed under regional anaesthesia in patients with chronic obstructive pulmonary disease. Surg Endosc 2002;16(3):472–5.
Kim YI, Lee JS, Jin HC, Chae WS, Kim SH. Thoracic epidural anaesthesia for laparoscopic cholecystectomy in an elderly patient with severely impaired pulmonary function tests. Acta Anaesthesiol Scand 2007;51(10):1394–6.
Savas JF, Litwack R, Davis K, Miller TA. Regional anaesthesia as an alternative to general anaesthesia for abdominal surgery in patients with severe pulmonary impairment. Am J Surg 2004;188(5):603–5.
Ahmed I. Laparoscopic cholecystectomy using spinal anaesthesia. Br J Anaesth 2007;99(5):744–5.
Kim JT, Shim JK, Kim SH, Jung CW, Bahk JH. Trendelenburg position with hip flexion as a rescue strategy to increase spinal anaesthetic level after spinal block. Br J Anaesth 2007;98(3):396–400.
Lee JH, Huh J, Kim DK, Gil JR, Min SW, Han SS. Laparoscopic cholecystectomy under epidural anaesthesia: a clinical feasibility study. Korean J Anesthesiol 2010;59(6):383–8.
Bessa SS, Katri KM, Abdel-Salam WN, El-Kayal el-SA, Tawfik TA. Spinal versus general anaesthesia for day-case laparoscopic cholecystectomy: A prospective randomized study. J Laparoendosc Adv Surg Tech A 2012;22(6):550–5.
Yuksek YN, Akat AZ, Gozalan U, Daglar G, Pala Y, Canturk M, et al. Laparoscopic cholecystectomy under spinal anaesthesia. Am J Surg 2008;195(4):533–6.
Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal vs general anaesthesia for laparoscopic cholecystectomy: Interim analysis of a controlled randomized trial. Arch Surg 2008;143(5):497–501.
Sinha R, Gurwara AK, Gupta SC. Laparoscopic surgery using spinal anaesthesia. JSLS 2008;12(2):133–8.
Gupta A, Gupta K, Gupta PK, Agarwal N, Rastogi B. Efficacy of thoracic epidural anaesthesia for laparoscopic cholecystectomy. Anesth Essays Res 2011;5(2):138–41.
Ali Y, Elmasry MN, Negmi H, Al Ouffi H, Fahad B, Rahman SA. The feasibility of spinal anaesthesia with sedation for laparoscopic general abdominal procedures in moderate risk patients. Middle East J Anaesthesiol 2008;19(5):1027–39.
Pal I, Bhatti U, Bari J. Changing trends in surgical management for acute cholecystitis,in light of Tokyo guidelines - 14 year experience. J Pak Med Assoc 2019;69(10):1505–8.
Das W, Bhattacharya S, Ghosh S, Saha S, Mallik S, Pal S. Comparison between general anaesthesia and spinal anaesthesia in attenuation of stress response in laparoscopic cholecystectomy: A randomized prospective trial. Saudi J Anaesth 2015;9(2):184–8.