Segmental spinal vs general anaesthesia in patients undergoing laparoscopic cholecystectomy: A comparative study

Paliwal, Naresh Wamanrao; Ingle, Jayesh; Lawhale, Sunil; Dhakulkar, Amol

doi:10.26611/10151431

Cited by 5 publications

(6 citation statements)

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“…Previous studies compared TSSA and GA and concluded that TSSA provides better hemodynamic stability without much vasopressor use, early ambulation and discharge and increased patient satisfaction. 5,6 There have also been studies of laparoscopic cholecystectomy under lumbar spinal anaesthesia using hyperbaric local anaesthetic drugs. This entails extensive sympathetic blockade leading to dangerous hypotension as opposed to TSSA in which only targeted spinal segments are blocked with isobaric local anaesthetic drugs and there is minimal haemodynamic fluctuation.…”

Section: Discussionmentioning

confidence: 99%

“…The intercostal muscles, which are the muscles mainly used in forced expiration, are not affected much because the motor blockade in TSSA is very minimal and transient. 6,11 The third point of concern is the fact that the cardio accelerator nerve fibres arise from T1-T4 segments and a high neuraxial block could lead to serious bradycardia due to vagal preponderance. This however does not happen as the lumbosacral nerves are spared and there is no pooling of blood in the lower limbs.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy and safety of segmental spinal anaesthesia in laparoscopic cholecystectomy: A prospective study

Singhal¹,

Mathur²,

Mathur³

2023

IJCA

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Laparoscopic cholecystectomy is usually conducted under general anaesthesia(GA) which has its own limitations and may be associated with certain complications. This single-arm prospective interventional study was done to assess the safety and efficacy of thoracic segmental spinal anaesthesia(TSSA) as a sole anaesthetic procedure in patients undergoing laparoscopic cholecystectomy. TSSA was administered to 50 patients of the American Society of Anaesthesiologists physical status 1, 2, 3, who were scheduled for elective laparoscopic cholecystectomy (1.5 ml of 0.75% ropivacaine with dexmedetomidine 6 µg as an adjuvant was injected in one of the intervertebral spaces between T7- T12). The primary objective of the study was to evaluate the efficacy and safety of TSSA to provide complete surgical anaesthesia in terms of the total number of cases converted to GA. The data was analysed using SciPy(version 1.3.1), a statistical analysis package, in Python programming language (version 3.7.4). Our study revealed that TSSA provided complete surgical anaesthesia in 48 patients and in two patients there was a failure to achieve adequate sensory block and GA had to be administered. The median time for full sensory regression was 90 min and the median time for complete motor regression was 60 min. No major intraop or postop adverse event was noted.TSSA offers safe and satisfying operating conditions for elective laparoscopic cholecystectomy. This technique practised with caution can provide a useful alternative to GA, especially in conditions where GA may have limitations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of segmental spinal anaesthesia in laparoscopic cholecystectomy: A prospective study

Singhal¹,

Mathur²,

Mathur³

2023

IJCA

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“…Paliwal et al in a study compared segmental spinal versus GA for laparoscopic cholecystectomy on 60 patients and concluded that segmental spinal can prove to be a better choice in patients particularly with respiratory co-morbidities, with lower incidence of postoperative pneumonia and atelectasis [ 14 ]. Ellakany et al conducted a randomized controlled study in 60 patients planned for open surgeries due to abdominal malignancies comparing segmental thoracic spinal and GA [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study

Chandra¹,

Misra²,

Datta³

2023

Cureus

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Background: The expanding horizons of the application of Segmental Thoracic Spinal anesthesia in day-today anesthesia practice prompted us to perform this study in a large subset of healthy patients with the aim of determining the feasibility, safety, advantages, and complications of this mode of anesthesia.Material and methods: The prospective observational study was conducted from April 2020 to March 2022, 2.146 patients with symptoms of cholelithiasis and planned for laparoscopic cholecystectomy were included in this study, and 44 patients from this study were excluded due to pre-defined exclusion criteria. The patients belonging to ASA lIl, lV, severe cardiovascular or renal disability, on beta blockers, coagulation anomaly, spinal deformities, or previous spine surgeries were not included in the study. The patients exhibiting allergy to local anesthetics, requiring more than two attempts for the procedure, patchy or inadequate effects after spinal anesthesia, or change in the plan of surgery intraoperatively were also excluded from the study. All other patients were given subarachnoid block at T10-T11 intervertebral space with 26G Quincke needle and Inj. Bupivacaine Heavy (0.5%) 2.4 mL with 5µg of Dexmedetomidine. Intraoperative parameters, number of attempts, the incidence of paresthesia during the procedure intraoperative and postoperative complications, and patient satisfaction were evaluated and recorded.Results: Spinal anesthesia was successful in 2,074 patients and was achieved in a single attempt of procedure in 92% of patients. The incidence of paresthesia during needle insertion was 5.8%. Hypotension was observed in 18% of patients, bradycardia (13%), and nausea (10%) in a few patients, with shoulder tip pain in only 6% of patients. The majority of patients (94%) were "very satisfied" with the procedure. There were no episodes of any adverse event during the postoperative period.Conclusion: Thoracic spinal anesthesia is a regional anesthesia technique practically feasible for healthy patients undergoing laparoscopic cholecystectomy with a manageable incidence of intraoperative complications and no evidence of any neurological complications. It has the advantage of providing manageable hemodynamics, minimal postoperative complication, and an acceptable degree of patient satisfaction.

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“…5 The term segmental spinal means blocking of the required dermatomes essential for the proposed surgical procedure with very low effective local anesthetic drug dose. 6 As mentioned above, initially, there were only two proposed sites for spinal anesthesia, with the middle thoracic were deemed unnecessary. Most anesthesiologists are hesitant to perform spinal anesthesia above the termination of the conus medullaris due to fear of injuring the spinal cord.…”

Section: Discussionmentioning

confidence: 99%

Thoracal Segmental Spinal Anesthesia for Lower Back Lipoma Excision

Suryo¹,

Widana²

2022

MEDICINUS

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Background: General anesthesia is the most preferred anesthetic management for lower back surgery, considering the location and practicality. However, multiple studies showed that regional anesthesia, particularly thoracal segmental, spinal anesthesia, had more advantages compared to general anesthesia. Case presentation: We report a 19-year-old woman admitted to the OR for infected lipoma in lower back region, located in thoracal 12th, who underwent successful thoracal segmental spinal anesthesia. Conclusion: This is an original case report which showed significance of thoracal segmental spinal anesthesia and the advantages compared to general anesthesia.

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Segmental spinal vs general anaesthesia in patients undergoing laparoscopic cholecystectomy: A comparative study

Cited by 5 publications

References 0 publications

Efficacy and safety of segmental spinal anaesthesia in laparoscopic cholecystectomy: A prospective study

Efficacy and safety of segmental spinal anaesthesia in laparoscopic cholecystectomy: A prospective study

Thoracic Spinal Anesthesia for Laparoscopic Cholecystectomy: An Observational Feasibility Study

Thoracal Segmental Spinal Anesthesia for Lower Back Lipoma Excision

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