Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study

Abstract

PurposeLaparoscopic appendectomy (LA) is routinely performed under general, not regional anesthesia. This study assessed the feasibility, efficacy, and side effects of combined spinal-epidural anesthesia (CSEA) in LA.MethodsThirty-three American Society of Anesthesiologist (ASA) physical status classification grade I patients underwent LA under CSEA. CSEA was performed using the needle-through-needle technique at the L3–L4 interspace. Preoperative and postoperative adverse events related to CSEA, patient satisfaction, and postoperative pain levels were recorded.ResultsLA under CSEA was performed successfully in 33 patients (84.6%). Peroperatively, right shoulder pain was observed in 8 patients (24.1%), abdominal discomfort in 6 (18.2%), anxiety in 5 (15.2%), hypotension in 2 (6.1%) and nausea-vomiting in 1 (3%). In the first 24 hours after LA, headache, urinary retention, right shoulder pain, and postoperative nausea/vomiting (PONV) occurred in 18.1%, 12.1%, 9.1%, and 0% of patients, respectively. In the first 6 hours postoperation, no patients had operation-site pain that required analgesic treatment. Thirty-one patients (94%) evaluated their satisfaction with the procedure as good or moderate.ConclusionCSEA is an efficient and suitable anesthesia technique in LA for ASA physical status classification grade I healthy patients. CSEA is associated with good postoperative pain control and the absence of PONV and intubation-associated complications.

Spinal/epidural block as an alternative to general anesthesia for laparoscopic appendectomy: a prospective randomized clinical study.

“…Laparoscopic appendectomies are usually performed under controlled ventilated GA with endotracheal intubation. This study shows that SEA may be an alternative technique to GA for laparoscopic appendectomies and reinforces previous feasibility studies [ 16 – 19 ]. It has been reported that sensorial block level should be at least the T4–T6 level for LA under spinal anesthesia [ 16 , 17 ].…”

“…Moreover, in our previous feasibility study we also found that similar rates of perioperative and postoperative adverse events related to spinal/epidural anesthesia and pneumoperitoneum in LA patients [ 19 ].…”

“…Intra-abdominal pressure increase secondary to pneumoperitoneum may result in abdominal discomfort/pain, and this may reduce the tolerance of laparoscopic surgery under regional anesthesia. Abdominal discomfort/pain was observed in LA under spinal anesthesia with 12.5–23.1% incidence [ 16 , 17 , 19 ]. In our study, we observed that abdominal discomfort/pain might result in anxiety in awake patients.…”

“…Hypotension is one of the serious complications of regional anesthesia and is related to peripheral vasodilatation and a decrease in venous return due to the sympathetic block [ 22 , 23 ]. Hypotension incidence in LA under spinal anesthesia was reported as 6.1–12.5% [ 16 , 17 , 19 ]. In our study we observed minimal cardiovascular changes.…”

Laparoscopic appendectomy for acute appendicitis: How to discourage surgeons using inadequate therapy

“…Clinically, many surgeons believe that LA is an appropriate treatment[ 76 ]. However, LA requires general anesthesia, although LA under combined spinal-epidural or local anesthesia is currently being attempted[ 140 , 141 ]. LA in a semi-elective manner (within 24 h after onset of symptoms) may be beneficial for avoiding uncomfortable situations for anesthetic induction, such as a full stomach and dehydration[ 142 , 143 ].…”