Laparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.

BackgroundLaparoscopic cholecystectomy has the advantages of causing less postoperative pain and requiring a short hospital stay, and therefore is the treatment of choice for cholelithiasis. This study was designed to compare spinal anesthesia using hyperbaric bupivacaine given as a conventional dose by lumbar puncture or as a low-dose by thoracic puncture.MethodsA total of 140 patients with symptomatic gallstone disease were randomized to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under spinal anesthesia using either conventional lumbar spinal anesthesia (hyperbaric bupivacaine 15 mg and fentanyl 20 mg) or low-dose thoracic spinal anesthesia (hyperbaric bupivacaine 7.5 mg and fentanyl 20 μg). Intraoperative parameters, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two treatment groups.ResultsAll procedures were completed under spinal anesthesia, with no cases needing conversion to general anesthesia. Values for time for block to reach the T3 dermatomal level, duration of motor and sensory block, and hypotensive events were significantly lower with low-dose bupivacaine. Postoperative pain was higher for low-dose hyperbaric bupivacaine at 6 and 12 hours. All patients were discharged after 24 hours. Follow-up 1 week postoperatively showed all patients to be satisfied and to be keen advocates of spinal anesthesia.ConclusionLaparoscopic cholecystectomy can be performed successfully under spinal anesthesia. A small dose of hyperbaric bupivacaine 7.5 mg and 20 μg fentanyl provides adequate spinal anesthesia for laparoscopy and, in comparison with hyperbaric bupivacaine 15% and fentanyl 20 μg, causes markedly less hypotension. The low-dose strategy may have an advantage in ambulatory patients because of the earlier recovery of motor and sensory function and earlier discharge.

This case provides evidence that segmental spinal block can be the anesthetic technique used in gastrointestinal surgeries with spontaneous respiration.

Summary: Imbelloni LE, Fornasari M, Fialho JC, Sant'Anna R, Cordeiro JA -General Anesthesia versus Spinal Anesthesia for Laparoscopic Cholecystectomy. Background and objectives:Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia.

Background: 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 retrospective study with patients undergoing laparoscopic cholecystectomy under thoracic spinal anesthesia. Methods: A total of 505 laparoscopic cholecystectomy patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T8 to T11, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with two doses of 0.5% bupivacaine hyperbaric plus 25 µg of fentanyl, until reaching the sensitive level of T3. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia, bradycardia, hypotension, anesthesia success and neurological complications. Results: All 505 patients developed spinal. Neither the dose of hyperbaric solution of 0.5% bupivacaine nor the addition of fentanyl affected the onset of sensory block. The duration of sensory block was greater than the motor block with hyperbaric solution. Bradycardia occurred in 16 (3.1%) patients, and was not correlated with the level of thoracic puncture. Hypotension occurred in 82 (16.2%), with no significant association with the dose of local anesthetic. None of the 505 patients had the maximum degree of lower limb motor block, with significant difference in terms of dose. Paresthesia was observed in 28 (5.5%) without significant difference between needles. All paresthesias were transient and without residual sequelae. Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery, without neurological sequelae.