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. 2017 Apr;92(4):208-213.
doi: 10.4174/astr.2017.92.4.208. Epub 2017 Mar 24.

Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study

Sinan Uzman  1 , Turgut Donmez  2 , Vuslat Muslu Erdem  3 , Adnan Hut  4 , Dogan Yildirim  4 , Muzaffer Akinci  4
Affiliations

Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study

Sinan Uzman et al. Ann Surg Treat Res. 2017 Apr.

Abstract

Purpose: Laparoscopic appendectomy (LA) is routinely performed under general, not regional anesthesia. This study assessed the feasibility, efficacy, and side effects of combined spinal-epidural anesthesia (CSEA) in LA.

Methods: Thirty-three American Society of Anesthesiologist (ASA) physical status classification grade I patients underwent LA under CSEA. CSEA was performed using the needle-through-needle technique at the L3-L4 interspace. Preoperative and postoperative adverse events related to CSEA, patient satisfaction, and postoperative pain levels were recorded.

Results: LA under CSEA was performed successfully in 33 patients (84.6%). Peroperatively, right shoulder pain was observed in 8 patients (24.1%), abdominal discomfort in 6 (18.2%), anxiety in 5 (15.2%), hypotension in 2 (6.1%) and nausea-vomiting in 1 (3%). In the first 24 hours after LA, headache, urinary retention, right shoulder pain, and postoperative nausea/vomiting (PONV) occurred in 18.1%, 12.1%, 9.1%, and 0% of patients, respectively. In the first 6 hours postoperation, no patients had operation-site pain that required analgesic treatment. Thirty-one patients (94%) evaluated their satisfaction with the procedure as good or moderate.

Conclusion: CSEA is an efficient and suitable anesthesia technique in LA for ASA physical status classification grade I healthy patients. CSEA is associated with good postoperative pain control and the absence of PONV and intubation-associated complications.

Keywords: Appendicitis; Epidural anesthesia; Laparoscopy; Spinal anesthesia.

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Conflict of interest statement

CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Flowchart of the study. CSEA, combined spinal/epidural anesthesia.
See this image and copyright information in PMC

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