Laparoscopic cholecystectomy under spinal anesthesia.
BACKGROUND
Advantages of laparoscopic cholecystectomy (LC) such as less pain and short hospital stay make it the treatment of choice for cholelithiasis. There are limited data about LC under spinal anesthesia. This study was designed to evaluate LC under spinal anesthesia.


METHODS
Twenty-nine patients underwent surgery for LC under spinal anesthesia at the 4th Department of Surgery of the Ankara Numune Education and Research Hospital between April 2005 and January 2006. All patients were informed about spinal anesthesia in detail. The patients also were informed about the risk of conversion to general anesthesia, and all patients provided informed consent. The election criteria for spinal anesthesia were as follows: American Society of Anesthesiologists (ASA) risk group 1 or 2; risk score for conversion from LC to open cholecystectomy (RSCO) less than negative 3; and presence of gallstone disease. Standard laparoscopic technique was applied to all patients. Simple questionnaire forms were developed for both patients and surgeons to provide comments about the operation.


RESULTS
The operation was completed laparoscopically on 26 patients, while 3 patients needed general anesthesia due to severe right shoulder pain. None of the patients had cardiopulmonary problems other than transient hypotension during surgery. Intravenous fentanyl (25 microg) was needed in 13 patients due to severe right shoulder pain. Five patients still had severe shoulder pain after fentanyl injection. Local washing of the right diaphragm with 2% lidocaine solution was successful in the remaining 5 patients in whom fentanyl injection failed to stop the pain. All of the patients' answers to the questions regarding the comfort of operation were "very well" at the 1-month postoperative evaluation. All surgeons stated that there was no difference from LC under general anesthesia.


CONCLUSIONS
All of the patients and surgeons were satisfied with LC under spinal anesthesia. Therefore, LC under spinal anesthesia may be an appropriate treatment choice to increase the number of patients eligible for outpatient surgery.
Yuksek
Yunus Nadi
YN
4th Department of Surgery, Ankara Numune Hospital, Ankara, Turkey. ynyuksek@yahoo.com
Akat
Arif Zeki
AZ
Gozalan
Ugur
U
Daglar
Gul
G
Pala
Yasar
Y
Canturk
Mehmet
M
Tutuncu
Tanju
T
Kama
Nuri Aydin
NA
D000759:Adjuvants, Anesthesia / Q000008:administration & dosage; D000328:Adult; D000368:Aged; D000577:Amides / Q000008:administration & dosage; D000701:Analgesics, Opioid / Q000008:administration & dosage; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D000779:Anesthetics, Local / Q000008:administration & dosage*; D002045:Bupivacaine / Q000008:administration & dosage; D017081:Cholecystectomy, Laparoscopic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D053591:Referred Pain / Q000188:drug therapy / Q000209:etiology; D000077212:Ropivacaine; D012782:Shoulder; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D000759:Adjuvants, Anesthesia; D000577:Amides; D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000077212:Ropivacaine; D005283:Fentanyl; D002045:Bupivacaine