Yousef Gamal T, Lasheen Ahmed E
Department of Anesthesia and Intensive Care, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
General Surgery Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
Anesth Essays Res. 2012 Jul-Dec;6(2):167-73. doi: 10.4103/0259-1162.108302.
Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation.
This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction.
A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO2 pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T3 sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups.
All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T3 level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA.
The present study not only confirmed that both segmental TSA and conventional lumber spinal anesthesia (LSA) are safe and good alternatives to general anesthesia (GA) in healthy patients undergoing laparoscopic cholecystectomy but also showed better postoperative pain control of both spinal techniques when compared with general anesthesia. Segmental TSA provides better hemodynamic stability, lesser vasopressor use and early ambulation and discharge with higher degree of patient satisfaction making it excellent for day case surgery compared with conventional lumbar spinal anesthesia.
由于术后疼痛轻、呼吸功能影响小且能早期活动，腹腔镜胆囊切除术已成为胆结石疾病的标准手术方式。
本研究旨在比较脊髓麻醉（节段性胸椎或传统腰椎麻醉）与金标准全身麻醉这三种麻醉技术，用于择期腹腔镜胆囊切除术的健康患者，评估术中参数、术后恢复与镇痛、并发症以及患者和外科医生的满意度。
2010年1月至2011年5月期间，共有90例行择期腹腔镜胆囊切除术的患者被随机分为三组，分别在节段性胸椎（TSA组）或传统腰椎（LSA组）脊髓麻醉或全身麻醉（GA组）下，采用低压二氧化碳气腹进行腹腔镜胆囊切除术。为达到T3感觉平面，LSA组在L2/L3使用（重比重布比卡因15mg和芬太尼25mg），TSA组在T10/T11使用（重比重布比卡因7.5mg和芬太尼25mg）。GA组使用丙泊酚、芬太尼、阿曲库铵、七氟醚并进行气管插管。比较三组的术中参数、术后恢复与镇痛、并发症以及患者和外科医生的满意度。
所有手术均通过分配的麻醉方法在腹腔镜下完成，无麻醉方式转换。（TSA组）达到T3平面的阻滞时间、术中低血压和心动过缓事件以及血管升压药的使用明显低于（LSA组）。与（GA组）相比，（TSA组）和（LSA组）在任何时间点评估的术后疼痛评分、术后右肩疼痛和住院时间均较低。节段性TSA麻醉下患者的满意度评分更高。
本研究不仅证实节段性TSA和传统腰椎脊髓麻醉（LSA）在接受腹腔镜胆囊切除术的健康患者中是全身麻醉（GA）安全且良好的替代方法，而且与全身麻醉相比，两种脊髓麻醉技术在术后疼痛控制方面表现更佳。与传统腰椎脊髓麻醉相比，节段性TSA提供更好的血流动力学稳定性，更少的血管升压药使用，更早的活动和出院，患者满意度更高，使其非常适合日间手术。
Zotero 插件