Calvo-Soto P, Trujillo-Hernández B, Martínez-Contreras A, Vásquez C

Language: English
References: 16
Page: 482-488
PDF size: 61.83 Kb.

ABSTRACT

Objective. Combined spinal and general anesthesia block (CSGAB) and combined epidural and general anesthesia block (CEGAB) in laparoscopic cholecystectomy were compared. Material and methods. Forty patients were randomly selected (ASA physical status I-II) to receive sevoflurane plus 10 to 15 mg of bupivacaine weighed at 0.5% and 20 µg of fentanyl (CSGAB) or sevoflurane plus 150 mg of ropivacaine and 1 µg/kg of fentanyl (CEGAB). Blood pressure, heart rate, oxygen and carbon dioxide saturation, drug doses and sevoflurane MAC (minimum alveolar concentration) were evaluated during surgery. Anesthesia recovery time and pain intensity and duration were evaluated during the first two postoperative hours. Frequency of incisional or referred pain, dyspnea, headache, cramping, nausea and vomiting were evaluated 24 hours after surgery. Statistical analysis was carried out using the Chi-square test and Student t test. Relative risk, absolute risk reduction and number needed to treat (NNT) for adverse reactions were determined. Results. Systolic and diastolic arterial pressures posterior to semi-Fowler’s position were lower in the CSGAB group than in the CEGAB group. (94 ± 16 vs. 110 ± 18 mmHg; p ‹ 0.01 and 59 ± 8 vs. 69 ± 12, mmHg; p ‹ 0.01, respectively). Anesthesia recovery time (32 ± 17 vs. 61 ± 29 minutes; p ‹ 0.01) and pain duration (26 ± 42 vs. 83 ± 46 minutes; p ‹ 0.01) were shorter in the CSGAB group. NNT was 8 for postoperative pain, 8 for nausea, and 95 for vomiting. Conclusions. CSGAB was more efficacious for rapid anesthesia recovery and had a shorter post-operative pain duration than CEGAB.

REFERENCES

1. Rigg JRA. Does regional block improve outcome after surgery? Anaesth Intensive Care 1991; 19: 404-11.

2. Liu S, Carpenter RL, Neal JM. Epidural anesthesia and analgesia: their role in postoperative outcome. Anesthesiology 1995; 82: 1474-506.

3. Rigg JRA, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet 2002; 359: 1276-82.

4. Yeager MP, Glass DD, Neff RK, Brinck-Johnsen T. Epidural anesthesia and analgesia in high risk surgical patients. Anesthesiology 1987; 66: 729-36.

5. Davies MJ, Silbert BS, Money PJ, Dysart RH, Meads AC. Combined epidural and general anaesthesia for abdominal aortic surgery: a prospective randomised trial. Anaesth Intensive Care 1993; 21: 790-4.

6. Stewart AV, Vaghadi H, Collins L, Mitchell GW. Small-dose selective spinal anaesthesia for short-duration outpatient gynaecological laparoscopy: recovery characteristics compared with propofol anaesthesia. Br J Anaesth 2001; 86: 570-2.

7. Lennox PH, Vaghadia H, Henderson C, Martin L, Mitchell GW. Small-dose selective spinal anaesthesia for short-duration outpatient laparoscopy:recovery characteristics compared with desfluorane anaesthesia. Anesth Analg 2002; 94: 346-50.

8. Luchetti M, Palomba R, Sica G, Massa G, Tufano R. Effectiveness and safety of combined epidural and general anesthesia for laparoscopic cholecystectomy. Reg Anesth 1996; 21: 465-9.

9. Yokoyama M, Ohta Y, Hirakawa M, Tsuge H. Hemodynamic changes during laparoscopic cholecystectomy under different anesthesia methods. Masui 1996; 45: 160-6.

10. Aono H, Takeda A, Tarrer SD, Goto H. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy. J Clin Anesth 1998; 10: 546-50.

11. Folsgaard SL, Hemmingsen C, Frey-Larsen SE, Jacobsen E. Complications of spinal anesthesia compared to general anesthesia. A prospective study of 408 consecutive orthopedic patients. Ugeskt Laeger 1993; 155: 1199-202.

12. Lennox PH, Chilvers C, Vaghadia H. Selective spinal anaesthesia versus desflurane anesthesia in short duration outpatient gynecological laparoscopy: a pharmacoeconomic comparison. Anesth Analg 2002; 94: 565-8.

13. Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg 2001; 167: 84-96.

14. Lee IO, Kim SH , Kong MH, Lee MK, Kim NS, Choi YS, et al. Pain after laparoscopic cholecistectomy: the effect and timing of incisional and intraperitoneal bupivacaine. Can J Anaesth 2001 ; 48: 545-50.

15. Noma H, Kakiuchi H, Nojiri K, Izumi R, Tashiro C. Evaluation of postoperative pain relief by infiltration of bupivacaine or epidural block after laparoscopic cholecystectomy. Masui 2001; 50: 1201-04.

16. Bisgaard T, Klarskov B, Kristiansen VB, Callesen T, Schulze S, Kehlet H, et al. Multi-regional local anesthetic infiltration during laparoscopic cholecystectomy in patients receiving prophylactic multi-modal analgesia: a randomized, doubleblinded, placebo-controlled study. Anesth Analg 1999; 89: 1017-24.