Mazzone Chiara, Sofia Maria, Sarvà Iacopo, Litrico Giorgia, Di Stefano Andrea Maria Luca, La Greca Gaetano, Latteri Saverio
Dipartimento di Scienze Mediche, Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", Università degli Studi di Catania, Catania 95123, Italy.
World J Clin Cases. 2023 May 6;11(13):3002-3009. doi: 10.12998/wjcc.v11.i13.3002.
Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.
A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.
Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.
腹腔镜胆囊切除术（LC）是腹部外科中应用最广泛的手术之一。患者在全身麻醉下接受LC；然而，近年来，多项研究表明在清醒患者中也能进行LC。我们报告一例清醒LC病例并进行文献综述。
一名69岁患有严重肺部疾病且合并胆结石的患者计划在区域麻醉下接受LC。我们首先在T8 - T9水平进行硬膜外麻醉，然后在T12 - L1水平进行脊髓麻醉。手术过程中患者和外科医生都感觉非常舒适。腹内压为8 mmHg。患者在整个手术过程中保持稳定，术后过程顺利。
有证据表明脊髓麻醉和硬膜外麻醉的安全使用，其副作用极小，通过药物易于处理。在特定患者中，区域麻醉可能比全身麻醉具有一些优势，如无需气道操作、维持自主呼吸、有效的术后镇痛、较少的恶心和呕吐以及早期恢复。然而，这种LC技术在欧洲并未广泛应用；这是意大利文献中报道的首例病例。区域麻醉在进行某些类型的腹腔镜手术中是可行且安全的。应开展进一步研究以将这种麻醉方式引入常规临床实践。
