Laparoscopic Cholecystectomy Under Combined Spinal/ Epidural Anesthesia: A Retrospective Analysis of 112 Cases in Terms of Per- and Postoperative Outcomes

Özet

Introduction: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of benign gall bladder diseases. The use of spinal (SA), epidural (EA), and combined spinal epidural anesthesia (CSEA) has increased in recent years. Methods: A total of 112 patients who underwent elective LC under CSEA for gall stones or polyps were retrospectively analyzed. Low-pressure CO2 pneumoperitoneum was used, and standard LC was performed. Patient demographics, ASA scores, comorbidities, surgery, anesthesia, and total time were recorded. Intraoperative complications (hypotension, bradycardia, hypoxemia, nausea/vomiting, right shoulder pain, anxiety or abdominal discomfort, and/or pain) were recorded. Postoperative shoulder pain, postdural puncture headache (PDPH), nausea/vomiting, urinary retention, anxiety, and abdominal discomfort and/or pain were also recorded. Results: LC was successful in all patients, except one. Seventy patients had VAS0=0, 40 (35.7%) had VAS0 <1, and two (1.8%) had VAS0 ≤2. The patient satisfaction score was 4 or 5 for 84.8% of patients. There was intraoperative abdominal discomfort, shoulder pain, and anxiety in 26 (23.2%), 13 (11.6%), and eight (7.1%) patients, respectively. Two patients (1.8%) developed intraoperative hypotension. Postoperatively, shoulder pain, urinary retention, nausea and vomiting, and PDPH were observed in 10 (8.9%), six (5.4%), four (3.6%), and four (3.6%) patients, respectively. Discussion and Conclusion: LC under CSEA with low-pressure CO2 pneumoperitoneum is feasible and safe.