Epidural anaesthesia for laparoscopic cholecystectomy in a patient with scleroderma

Sülemanji, Demet; Dönmez, Aslı; Arslan, Gülten

doi:10.1093/bja/ael260

Cited by 12 publications

(9 citation statements)

References 1 publication

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“…Consequently, the use of regional anesthesia (RA) in laparoscopic surgery has been limited to patients at high risk for GA due to severe coexisting pulmonary, cardiac, or other disease. 5,8,9,11 Regional anesthesia has also been used for laparoscopy in fit patients in combination with general anesthesia for the pain-free postoperative period. There is no doubt that regional anesthesia has been successfully used for LC in patients unfit for general anesthesia, but surprisingly, has not been tried in fit patients.…”

Section: Introductionmentioning

confidence: 99%

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Singh

Saini

Goel³

et al. 2015

Medical Journal Armed Forces India

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Background: Laparoscopic surgeries have attained the status of a gold standard for most of the abdominal pathology; we therefore performed this study to assess feasibility and safety of major laparoscopic surgeries like laparoscopic cholecystectomy (LC) and laparoscopic assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) under regional anesthesia that is combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum using intrathecal fentanyl with bupivacain.Methods: In a zonal government hospital, 50 patients were selected prospectively for LC and LAVH/TLH, under normal pressure (12 mmHg) pneumoperitoneum and under CSE over a span of fifteen months. Injection bupivacaine (0.5%) and 20 mg of fentanyl were used for spinal anesthesia. Plain bupivacaine (0.5%) was used for epidural anesthesia.Results: We successfully performed the operations in 48 patients without major complications. CSE was converted to general anesthesia in two patients due to distressing shoulder tip pain. Age varied between 25 and 70 years. Duration of operation time (skin to skin) was between 50 and 170 min. Five patients had urinary retention and one developed localized pruritis. There was no incidence of respiratory depression, aspiration or headache.Conclusion: Laparoscopic surgeries with normal pressure CO 2 pneumoperitoneum are feasible and safe under CSE. Incidence of postoperative shoulder pain was minimal due to use of intrathecal fentanyl and complications were less and easily manageable.

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Section: Introductionmentioning

confidence: 99%

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Singh

Saini

Goel³

et al. 2015

Medical Journal Armed Forces India

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“…Regional anesthesia may be limited, however, by technical difficulties, prolonged sensory blockade, unpredictable spread of local anesthetics,27,47,49,50 and associated with marked cardiovascular compromise 27…”

Section: The Use Of Regional Anesthesia In Systemic Sclerosismentioning

confidence: 99%

“…Prolonged sensory block is the most frequently quoted complication of regional anesthesia in these patients 8,14,15,18,20,23,27,50,52,53. However, of the 21 blocks identified, only seven resulted in abnormal duration of anesthesia, with all patients making a full recovery within 24 hours 18,20,23,52,53.…”

Section: The Use Of Regional Anesthesia In Systemic Sclerosismentioning

confidence: 99%

“…The six more recent case reports of neuroaxial anesthesia in patients with SSc do not report prolongation of block. Agents used were bupivacaine, ropivacaine, and prilocaine 27,49,50,55–57…”

Section: The Use Of Regional Anesthesia In Systemic Sclerosismentioning

confidence: 99%

“…Single shot spinals,27,51 epidurals,20,50,51,55–57 combined spinal epidurals (CSE)49 and continuous intrathecal catheter techniques2 have all been used successfully in patients with SSc. Fortunately the back is often spared in SSc1,27 and of the ten neuroaxial blocks described in the case reports, technical difficulties were only reported once 50. This was due to difficulties positioning the patient, caused by restricted joint movement and not sclerosis of the spine.…”

Section: The Use Of Regional Anesthesia In Systemic Sclerosismentioning

confidence: 99%

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The role of regional and neuroaxial anesthesia in patients with systemic sclerosis

Dempsey

Rowell²,

McRobert

2011

LRA

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Systemic sclerosis (SSc), previously known as progressive systemic sclerosis, is a form of scleroderma and a multisystem connective tissue disease which can impact on every aspect of anesthetic care, especially airway management. In this review we outline clinical manifestations and current medical treatment of the disease, and general principles of anesthetizing these patients. We focus on the role of regional anesthesia, including neuroaxial anesthesia, which may serve as a safe alternative to general anesthesia but can be technically challenging. We address concerns regarding abnormal responses to local anesthesia which have previously been reported in patients with SSc, and explore future developments in technology and pharmacology, which may enable regional anesthesia to be performed more successfully and with fewer complications.

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Regional anesthesia for laparoscopic surgery: a narrative review

Vretzakis

Bareka

Αρέθα³

et al. 2013

J Anesth

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Laparoscopic surgery has advanced remarkably in recent years, resulting in reduced morbidity and shorter hospital stay compared with open surgery. Despite challenges from the expanding array of laparoscopic procedures performed with the use of pneumoperitoneum on increasingly sick patients, anesthesia has remained largely unchanged. At present, most laparoscopic operations are usually performed under general anesthesia, except for patients deemed "too sick" for general anesthesia. Recently, however, several large, retrospective studies questioned the widely held belief that general anesthesia is the best anesthetic method for laparoscopic surgery and suggested that regional anesthesia could also be a reasonable choice in certain settings. This narrative review is an attempt to critically summarize current evidence on regional anesthesia for laparoscopic surgery. Because most available data come from large, retrospective studies, large, rigorous, prospective clinical trials comparing regional vs. general anesthesia are needed to evaluate the true value of regional anesthesia in laparoscopic surgery.

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Epidural anaesthesia for laparoscopic cholecystectomy in a patient with scleroderma

Cited by 12 publications

References 1 publication

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

Major laparoscopic surgery under regional anesthesia: A prospective feasibility study

The role of regional and neuroaxial anesthesia in patients with systemic sclerosis

Regional anesthesia for laparoscopic surgery: a narrative review

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