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. 2011:4:41-6.
doi: 10.2147/LRA.S19979. Epub 2011 Oct 3.

Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

Luiz Eduardo Imbelloni  1 , Raphael Sant'anna, Marcos Fornasari, José Carlos Fialho
Affiliations

Laparoscopic cholecystectomy under spinal anesthesia: comparative study between conventional-dose and low-dose hyperbaric bupivacaine

Luiz Eduardo Imbelloni et al. Local Reg Anesth. 2011.

Abstract

Background: Laparoscopic cholecystectomy has the advantages of causing less postoperative pain and requiring a short hospital stay, and therefore is the treatment of choice for cholelithiasis. This study was designed to compare spinal anesthesia using hyperbaric bupivacaine given as a conventional dose by lumbar puncture or as a low-dose by thoracic puncture.

Methods: A total of 140 patients with symptomatic gallstone disease were randomized to undergo laparoscopic cholecystectomy with low-pressure CO(2) pneumoperitoneum under spinal anesthesia using either conventional lumbar spinal anesthesia (hyperbaric bupivacaine 15 mg and fentanyl 20 mg) or low-dose thoracic spinal anesthesia (hyperbaric bupivacaine 7.5 mg and fentanyl 20 μg). Intraoperative parameters, postoperative pain, complications, recovery time, and patient satisfaction at follow-up were compared between the two treatment groups.

Results: All procedures were completed under spinal anesthesia, with no cases needing conversion to general anesthesia. Values for time for block to reach the T(3) dermatomal level, duration of motor and sensory block, and hypotensive events were significantly lower with low-dose bupivacaine. Postoperative pain was higher for low-dose hyperbaric bupivacaine at 6 and 12 hours. All patients were discharged after 24 hours. Follow-up 1 week postoperatively showed all patients to be satisfied and to be keen advocates of spinal anesthesia.

Conclusion: Laparoscopic cholecystectomy can be performed successfully under spinal anesthesia. A small dose of hyperbaric bupivacaine 7.5 mg and 20 μg fentanyl provides adequate spinal anesthesia for laparoscopy and, in comparison with hyperbaric bupivacaine 15% and fentanyl 20 μg, causes markedly less hypotension. The low-dose strategy may have an advantage in ambulatory patients because of the earlier recovery of motor and sensory function and earlier discharge.

Keywords: cholecystectomy; laparoscopic; spinal anesthesia.

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Figures

Figure 1
Figure 1
Pain scores on visual analog scale during the postoperative period.
See this image and copyright information in PMC

References

    1. Soper NJ, Stockman PT, Dunnegan DL, Ashley SW. Laparoscopic cholecystectomy: The new “gold standard”? Arch Surg. 1992;127:917–921. - PubMed
    1. Imbelloni LE, Fornasari M, Fialho JC, Sant’Anna R, Cordeiro JA. General anesthesia versus spinal block for laparoscopic cholecystectomy. Rev Bras Anestesiol. 2010;60:264–273. - PubMed
    1. Vaghadia H, McLeod DH, Mitchell GWE, Merrick PM, Chilvers CR. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. I. A randomized comparison with conventional dose hyperbaric lidocaine. Anesth Analg. 1997;84:59–64. - PubMed
    1. Chilvers CR, Vaghadia H, Mitchell GWE, Merrick PM. Small-dose hypobaric lidocaine-fentanyl spinal anesthesia for short duration outpatient laparoscopy. II. Optimal fentanyl dose. Anesth Analg. 1997;84:65–70. - PubMed
    1. Imbelloni LE, Quirici MB, Ferraz-Filho JR, Cordeiro JA, Ganem EM. The anatomy of the thoracic spinal canal investigated with magnetic resonance imaging. Anesth Analg. 2010;110:1494–1495. - PubMed

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