Laparoscopic surgery for benign adnexal conditions under spinal anaesthesia: Towards a multidisciplinary minimally invasive approach

Abstract

Background: Laparoscopic gynaecological surgery is commonly performed under general anaesthesia with endotracheal intubation. In general surgery, locoregional anaesthesia was applied to laparoscopic procedures, increasing minimally invasive surgery advantages. Aims: To assess and compare postoperative pain after laparoscopic adnexal procedures for benign conditions under spinal anaesthesia (SA) versus general anaesthesia (GA). Furthermore, anaesthesiologic, surgical and clinical data were evaluated in both groups. Materials and Methods: This is a prospective cohort study performed in a tertiary level referral centre for minimally invasive gynaecological surgery (Gynaecology and Human Reproduction Physiopathology, University of Bologna). Women scheduled for adnexal laparoscopic surgery for benign conditions between February and May 2019 were assigned to receive either SA or GA with endotracheal intubation. A sample size of 13 women per group was needed to detect a 2-point difference in pain scores. Main findings: 13 women were enrolled in the SA arm, 15 in the GA arm. In the SA cohort, the most common intraoperative adverse event was shoulder pain, reported by 3/12 women. At 1, 8, 12, 24 and 48 h after surgery pain was significantly lower in the SA arm (p < .05). Patients submitted to SA experienced no need for opioid drugs administration, unlike those receiving GA. Patients' mobilization and return of bowel function were noted significantly earlier in the SA group (p < .05). Conclusions: SA is a feasible, safe and effective anaesthesiologic technique for laparoscopic gynaecological procedures for benign conditions, allowing a better control of postoperative pain. Women undergoing SA achieve earlier mobilization and bowel canalization. During the Covid-19 pandemics, SA could be useful in reducing the need for invasive procedures on respiratory tract.

Spinal Anesthesia versus General Anesthesia in Gynecological Laparoscopic Surgery: A Systematic Review and Meta-Analysis

“…Two were randomized-clinical trials (RCTs) [14, 15], while the others were NRSs [3, 16] (Table 1). The 2 NRSs were prospective observational cohort studies [3, 16]. The total number of patients examined was 174: 86 cases and 88 controls.…”

“…Operative Times and Vomiting All 4 studies were included in the meta-analysis [3,[14][15][16], but only for "operative time" and "vomiting" parameters. The overall risk of bias of the included studies was low for RCTs and NRSs.…”

Laparoscopy in Gynecologic and Abdominal Surgery in Regional (Spinal, Peridural) Anesthesia, the Utility of the Technique during COVID-19 Pandemic

“…Moreover, the pneumoperitoneum is expected to be more important to respiratory dynamics apart from position changes [ 24 ]. In clinical observations [ 24 , 25 , 26 ], lung compliance declined more after withdrawal of pneumoperitoneum than before pneumoperitoneum was installed. Other studies have mentioned that lung compliance recovered to baseline right after the pneumoperitoneum was withdrawn.…”

“…The quick recovery in the postoperative period allows short time of urinary catheter and decreases the risk of infection. Reasons contributing to better postoperative pain control are to avoid a longer bed stay, which can cause the appearance of paralytic ileus, muscular pain and fatigue [ 25 ]. Intra- and post-operative advantages of SA combined with LRA were observed.…”

“…Significantly lower pain scores were reported compared to GA in the postoperative period. The significant difference was detected one hour after surgery and a statistically major 6-points difference in visual analog scale pain scoring (VAS) was recorded [ 25 ]. VAS is a validated, subjective measurement of acute and chronic pain, which we are using for our own study in laparoscopic surgery in SA.…”