Spinal Anaesthesia for Laparoscopic Appendectomy - Single Center Pilot Study

Laparoscopic Appendectomy

Abstract

Background: Appendectomy is commonly performed by laparoscopic method now-a-days because of its promising benefits over open method. The most commonly used and preferred mode of anaesthesia for laparoscopic abdominal surgeries is general anaesthesia with intubation and positive pressure ventilation. Studies regarding use of regional anaesthesia for laparoscopic abdominal surgeries are very limited. Therefore, this study was designed to conduct laparoscopic appendectomy with spinal anaesthesia as the first choice with contention that it can be better alternative to general anaesthesia. Subjects and Method: This was a single center pilot study conducted with permission and approval of institutional ethical committee.100 patients with ASA grade I and II belonging to age group 18 to 60 years diagnosed with acute appendicitis undergoing laparoscopic appendectomy were enrolled. Standard spinal anaesthesia procedure was carried out using 0.5% hyperbaric injection bupivacaine intrathecally. Injection ketamine 0.25 mg/kg injected intravenously just before pneumoperitoneum in view of management of shoul- der pain. Conversion of procedure to general anaesthesia and open surgical method, relief of shoulder pain, hemodynamic changes, postoperative complications, postoperative pain and postdural puncture headache were recorded and analysed. Result: The appendectomy procedure was completed laparascopically in 94 patients while only 6 patients required conversion to open method due to surgical factors. None of the patients had any cardiopulmonary complication except bradyarrythmia in 4 and transient hypotension in 10 patients which were managed successfully. No one needed conversion to general anaesthesia.5 patients complained about mild right shoulder pain. None of the patients complained about postdural puncture headache, postoperative nausea and vomiting. Only 3 patients required rescue analgesia postoperatively within 2 hours. Conclusion: Spinal anaesthesia using 0.5% hyperbaric bupivacaine and injection ketamine 0.25 mg /kg intravenously provided effective anaesthesia for laparoscopic appendectomy. It can be considered as a better alternative for general anaesthesia with minimal complications.