Imbelloni Luiz Eduardo, Fornasari Marcos, Fialho José Carlos, Sant'Anna Raphael, Cordeiro José Antonio
Hospital Rio Laranjeiras, Rio de Janeiro, RJ.
Rev Bras Anestesiol. 2010 May-Jun;60(3):217-27. doi: 10.1016/S0034-7094(10)70030-1.
Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia.
Between July 2007 and September 2008, 68 patients with symptoms of cholelithiasis were included in this study. Patients with physical status ASA I and II were randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO(2) under general anesthesia (n = 33) or spinal anesthesia (n = 35). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for general anesthesia. Hyperbaric bupivacaine 15 mg, and fentanyl 20 microg to achieve a sensorial level of T(3) were used for the spinal anesthesia. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between both groups.
All surgical procedures were completed with the chosen method and spinal anesthesia was converted to general anesthesia only in one patient. Pain was significantly lower at 2, 4, and 6 hours after the procedure under spinal anesthesia. The cost of the spinal anesthesia was significantly lower than that of the general anesthesia. All patients were discharged after 24 hours. In the postoperative evaluation, all patients were satisfied with the spinal anesthesia and would recommend this procedure.
Laparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.
腹腔镜胆囊切除术是治疗胆结石的首选方法。本研究的目的是比较在脊髓麻醉与全身麻醉下进行腹腔镜胆囊切除术的可能性。
2007年7月至2008年9月期间，68例有胆结石症状的患者纳入本研究。美国麻醉医师协会（ASA）身体状况分级为I级和II级的患者被随机分为两组，分别在全身麻醉（n = 33）或脊髓麻醉（n = 35）下接受低压力二氧化碳气腹腹腔镜胆囊切除术。全身麻醉使用丙泊酚、芬太尼、罗库溴铵、七氟醚并进行气管插管。脊髓麻醉使用15mg重比重布比卡因和20μg芬太尼以达到T3感觉平面。比较两组的术中参数、术后疼痛、并发症、恢复情况、患者满意度和费用。
所有手术均采用所选方法完成，仅1例患者脊髓麻醉转为全身麻醉。脊髓麻醉术后2、4和6小时的疼痛明显较轻。脊髓麻醉的费用明显低于全身麻醉。所有患者均在24小时后出院。在术后评估中，所有患者对脊髓麻醉均满意，并会推荐该方法。
采用二氧化碳低压力气腹的腹腔镜胆囊切除术可在脊髓麻醉下安全进行。与全身麻醉相比，脊髓麻醉术后疼痛程度极低，恢复更好，费用更低。
