Laparoscopic cholecystectomy under epidural anesthesia: A feasibility study

Abstract

Background:Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia.Aims:The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated.Materials and Methods:In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study.Results:The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia.Conclusions:The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

Re: Comment on: Comparison of Intraabdominal and Trocar Site Local Anaesthetic Infiltration on Postoperative Analgesia After Laparoscopic Cholecystectomy

“…In a study by Donmez et al (5) shoulder pain is observed in 60% of the cases where mean duration of surgery was 35 minutes. Likewise, in the study of Hajong et al (6), 50% shoulder pain was observed, where the mean duration of laparoscopic surgery was 44 minutes. In our study, mean duration of surgery was 45 minutes and there was shoulder pain in the 60% of the patients which was comperable with the literature.…”

Successful anesthetic management during abdominal wall-lifting laparoscopic cholecystectomy in a patient with hereditary angioedema

“…Laparoscopic gallbladder surgery, with pneumoperitoneum using carbon dioxide can be performed using spinal or epidural anesthesia [7][8][9]. However, radiating pain to the right shoulder, caused by the stimulation of the diaphragm by pneumoperitoneum with carbon dioxide or patient anxiety, is a risk factor for transitioning to general anesthesia [7][8][9][10].…”

“…Laparoscopic gallbladder surgery, with pneumoperitoneum using carbon dioxide can be performed using spinal or epidural anesthesia [7][8][9]. However, radiating pain to the right shoulder, caused by the stimulation of the diaphragm by pneumoperitoneum with carbon dioxide or patient anxiety, is a risk factor for transitioning to general anesthesia [7][8][9][10]. Referred pain caused by pneumoperitoneum may be induced by irritation of the phrenic nerve originating from the third to the fifth cervical nerves [13] and peritoneum innervated by the third to the sixth thoracic nerves [14][15][16], suggesting that analgesia level up to the cervical region is required to eliminate it.…”

“…Laparoscopic gallbladder surgery with pneumoperitoneum using carbon dioxide could be performed using spinal or epidural anesthesia [7][8][9]. However, radiation pain to the right shoulder caused by the stimulation of the diaphragm by pneumoperitoneum with carbon dioxide or anxiety of the patient becomes a risk factor for transitioning to general anesthesia [7][8][9][10]. In the present case, single-hole Nishii-type lifting laparoscopic surgery was performed without pneumoperitoneum [11,12] and did not involve carbon dioxide; therefore, the greatest cause for conversion to general anesthesia was avoided.…”

Laparotomic gastrostomy under aweake thoracic epidural anaesthesia: a prospering experience

“…[12] Lidocaine,bicarbonate-fentanyl combination has been used for abdominal operations in which the level of epidural block remained inadequate and thus had to be increased. [13] We also used the same combination to achieve an adequate level of anesthesia.…”