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

Abstract

IntroductionLaparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems.AimTo compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain.Material and methodsFifty patients, aged 18–65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) groups. Perioperative and postoperative adverse events, postoperative pain level, and patient satisfaction were compared between the groups.ResultsNone of the patients needed conversion to an open procedure or conversion from SEA to GA. In the SEA group we encountered shoulder pain in 6 (24%) patients, abdominal discomfort/pain in 4 (16%) patients, anxiety in 4 (16%) patients, and hypotension in 2 (8%) patients intraoperatively. Also, post-spinal headache was observed in 5 (20%) patients in the SEA group. Postoperative right shoulder pain was significantly higher in the GA group compared to the SEA group (32% vs. 8%; p = 0.037). In the SEA group the incidence of urinary retention and in the GA group the incidence of postoperative nausea and vomiting (PONV) were higher, but these differences were not statistically significant. The postoperative surgical pain level was significantly lower in the SEA group (p < 0.001).ConclusionsSpinal/epidural anesthesia is effective and safe in ASA I healthy patients undergoing LA. Less postoperative pain, PONV and shoulder pain are the advantages of SEA compared to GA.

Occurrence and Severity of Catheter-Related Bladder Discomfort of General Anesthesia Plus Epidural Anesthesia vs. General Anesthesia in Abdominal Operation With Urinary Catheterization: A Randomized, Controlled Study

“…The adverse events related to epidural anesthesia in patients who receive abdominal operation have been reported by previous studies. For instance, one previous study suggests that in patients who undergo laparoscopic appendectomy, the incidences of urinary retention and postoperative nausea and vomiting are higher in patients who receive epidural anesthesia compared to those who receive general anesthesia ( 22 ). Another interesting previous study finds that in patients who undergo laparoscopic cholecystectomy, the most frequently occurred adverse events related to epidural anesthesia are urinary retention as well as nausea and vomiting ( 23 ).…”

Low-pressure pulmonary recruitment maneuver: equal to or worse than moderate-pressure pulmonary recruitment maneuver in preventing postlaparoscopic shoulder pain? A randomized controlled trial of 72 patients.

“…Compared to conventional open surgical procedures LS enables a more pleasing postoperative course. Spinal anesthesia has been shown to result in less pain compared to general anesthesia in patients undergoing laparoscopic appendectomy [8]. Since one of the most critical advantages of LS is early ambulation, recent evidence indicates that mechanical or pharmacological thromboprophylaxis for prevention of venous thromboembolism is unnecessary in patients undergoing LS for benign causes [9].…”

Scoping review of mode of anaesthesia in emergency surgery

“…The 42 studies described outcomes in 436 310 patients, of whom 70·9 per cent were men ( Table ), and 47·1 per cent of patients had an ASA grade of III or higher. The most common procedure studied was hip fracture (22 studies), followed by endovascular stroke therapy (7) and ankle fracture fixation (3).…”