Erdem Vuslat Muslu, Donmez Turgut, Uzman Sinan, Ferahman Sina, Hatipoglu Engin, Sunamak Oguzhan
Department of Anesthesiology, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
Wideochir Inne Tech Maloinwazyjne. 2018 Jun;13(2):148-156. doi: 10.5114/wiitm.2018.72684. Epub 2018 Jan 16.
Laparoscopic appendectomy (LA) has been generally performed under general anesthesia. Laparoscopic appendectomy is rarely performed under regional anesthesia because of pneumoperitoneum-related problems.
To compare spinal/epidural anesthesia (SEA) and general anesthesia (GA) during LA with respect to perioperative and postoperative adverse events and postoperative pain.
Fifty patients, aged 18-65, who underwent LA, were randomly allocated to two groups: the GA (n = 25) and SEA (n = 25) groups. Perioperative and postoperative adverse events, postoperative pain level, and patient satisfaction were compared between the groups.
None of the patients needed conversion to an open procedure or conversion from SEA to GA. In the SEA group we encountered shoulder pain in 6 (24%) patients, abdominal discomfort/pain in 4 (16%) patients, anxiety in 4 (16%) patients, and hypotension in 2 (8%) patients intraoperatively. Also, post-spinal headache was observed in 5 (20%) patients in the SEA group. Postoperative right shoulder pain was significantly higher in the GA group compared to the SEA group (32% vs. 8%; p = 0.037). In the SEA group the incidence of urinary retention and in the GA group the incidence of postoperative nausea and vomiting (PONV) were higher, but these differences were not statistically significant. The postoperative surgical pain level was significantly lower in the SEA group (p < 0.001).
Spinal/epidural anesthesia is effective and safe in ASA I healthy patients undergoing LA. Less postoperative pain, PONV and shoulder pain are the advantages of SEA compared to GA.
腹腔镜阑尾切除术（LA）通常在全身麻醉下进行。由于与气腹相关的问题，腹腔镜阑尾切除术很少在区域麻醉下进行。
比较腹腔镜阑尾切除术期间脊髓/硬膜外麻醉（SEA）和全身麻醉（GA）在围手术期和术后不良事件及术后疼痛方面的情况。
50例年龄在18 - 65岁接受LA的患者被随机分为两组：GA组（n = 25）和SEA组（n = 25）。比较两组围手术期和术后不良事件、术后疼痛程度及患者满意度。
所有患者均无需转为开放手术或从SEA转为GA。在SEA组，术中6例（24%）患者出现肩部疼痛，4例（16%）患者出现腹部不适/疼痛，4例（16%）患者出现焦虑，2例（8%）患者出现低血压。此外，SEA组有5例（20%）患者出现脊麻后头痛。GA组术后右肩部疼痛明显高于SEA组（32%对8%；p = 0.037）。SEA组尿潴留发生率较高，GA组术后恶心呕吐（PONV）发生率较高，但这些差异无统计学意义。SEA组术后手术疼痛程度明显较低（p < 0.001）。
脊髓/硬膜外麻醉对于接受LA的ASA I级健康患者有效且安全。与GA相比，SEA的优势在于术后疼痛、PONV和肩部疼痛较少。
