Bejarano González-Serna Daniel, Utrera Antonio, Gallego José Ignacio, Rodríguez Rosalía, De la Portilla Fernando, Espinosa José Eduardo, Gil Manuel
Servicio de Cirugía General, Hospital Juan Ramón Jiménez, Huelva, España.
Cir Esp. 2006 Sep;80(3):168-70. doi: 10.1016/s0009-739x(06)70946-0.
Laparoscopic surgery is usually performed with the patient under general anesthesia. In open surgery, regional anesthesia has been found to have fewer adverse effects than general anesthesia. We studied whether spinal anesthesia is feasible in laparoscopic ventral hernia repair.
Bupivacaine and fentanyl were administered to obtain T2 block; midazolam was used for sedation. Patients underwent laparoscopic intraperitoneal hernia repair using an ePTFE prosthesis fixed with a double crown technique. An intra-abdominal pressure of 12 mmHg and low-flow insufflation (1.5 L/minute) were used for pneumoperitoneum.
Nineteen out of 23 patients underwent laparoscopic ventral hernia repair under spinal anesthesia; conversion to open surgery or general anesthesia was required in four patients. Additional sedation successfully relieved pain in patients with abdominal and shoulder discomfort (10.5%). Hypotension occurred in 68% of patients but was easily resolved by fluid administration.
Spinal anesthesia is feasible and well tolerated in laparoscopic hernia repair. Studies comparing spinal and general anesthesia in this field are warranted.
腹腔镜手术通常在患者全身麻醉下进行。在开放手术中，已发现区域麻醉的不良反应比全身麻醉少。我们研究了脊髓麻醉在腹腔镜腹疝修补术中是否可行。
给予布比卡因和芬太尼以获得T2阻滞；使用咪达唑仑进行镇静。患者采用双冠技术固定ePTFE假体进行腹腔镜腹腔内疝修补术。气腹时腹腔内压力为12 mmHg，采用低流量充气（1.5升/分钟）。
23例患者中有19例在脊髓麻醉下进行了腹腔镜腹疝修补术；4例患者需要转为开放手术或全身麻醉。额外的镇静成功缓解了腹部和肩部不适患者的疼痛（10.5%）。68%的患者发生低血压，但通过补液很容易得到解决。
脊髓麻醉在腹腔镜疝修补术中是可行的，且耐受性良好。有必要开展该领域脊髓麻醉与全身麻醉对比的研究。
