title: General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia.
  
  
  METHODS
  Between July 2007 and September 2008, 68 patients with symptoms of cholelithiasis were included in this study. Patients with physical status ASA I and II were randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO(2) under general anesthesia (n = 33) or spinal anesthesia (n = 35). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for general anesthesia. Hyperbaric bupivacaine 15 mg, and fentanyl 20 microg to achieve a sensorial level of T(3) were used for the spinal anesthesia. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between both groups.
  
  
  RESULTS
  All surgical procedures were completed with the chosen method and spinal anesthesia was converted to general anesthesia only in one patient. Pain was significantly lower at 2, 4, and 6 hours after the procedure under spinal anesthesia. The cost of the spinal anesthesia was significantly lower than that of the general anesthesia. All patients were discharged after 24 hours. In the postoperative evaluation, all patients were satisfied with the spinal anesthesia and would recommend this procedure.
  
  
  CONCLUSIONS
  Laparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.
authors.affiliation: Hospital Rio Laranjeiras, Rio de Janeiro, RJ.
authors.forename: Luiz Eduardo
authors.initials: LE
authors.lastname: Imbelloni
authors.forename: Marcos
authors.initials: M
authors.lastname: Fornasari
authors.forename: José Carlos
authors.initials: JC
authors.lastname: Fialho
authors.forename: Raphael
authors.initials: R
authors.lastname: Sant'Anna
authors.forename: José Antonio
authors.initials: JA
authors.lastname: Cordeiro
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D017081:Cholecystectomy, Laparoscopic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult