Imbelloni Luiz Eduardo, Sant'anna Raphael, Fornasari Marcos, Fialho José Carlos
Department of Anesthesiology, Faculty of Medecine Nova Esperança, Hospital de Mangabeira, João Pessoa.
Local Reg Anesth. 2011;4:41-6. doi: 10.2147/LRA.S19979. Epub 2011 Oct 3.
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.
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.
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.
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.
腹腔镜胆囊切除术具有术后疼痛轻、住院时间短的优点，因此是胆结石的首选治疗方法。本研究旨在比较通过腰椎穿刺给予常规剂量的重比重布比卡因或通过胸椎穿刺给予低剂量重比重布比卡因的脊髓麻醉效果。
总共140例有症状胆结石疾病患者被随机分配，在脊髓麻醉下接受低压二氧化碳气腹腹腔镜胆囊切除术，采用常规腰段脊髓麻醉（重比重布比卡因15mg和芬太尼20mg）或低剂量胸段脊髓麻醉（重比重布比卡因7.5mg和芬太尼20μg）。比较两个治疗组之间的术中参数、术后疼痛、并发症、恢复时间以及随访时患者的满意度。
所有手术均在脊髓麻醉下完成，无病例需要转为全身麻醉。低剂量布比卡因组在阻滞达到T3皮节水平的时间、运动和感觉阻滞持续时间以及低血压事件的值显著更低。低剂量重比重布比卡因在术后6小时和12小时的术后疼痛更高。所有患者在24小时后出院。术后1周随访显示所有患者均满意，并强烈支持脊髓麻醉。
腹腔镜胆囊切除术可在脊髓麻醉下成功进行。小剂量重比重布比卡因7.5mg和20μg芬太尼可为腹腔镜检查提供足够的脊髓麻醉，与15%重比重布比卡因和20μg芬太尼相比，引起的低血压明显更少。低剂量策略对于门诊患者可能具有优势，因为运动和感觉功能恢复更早且出院更早。
