title: Thoracic epidural anaesthesia for open cholecystectomy.
abstract: OBJECTIVE
  To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia.
  
  
  METHODS
  Quasi experimental study.
  
  
  METHODS
  The Combined Military Hospital, Skardu, from February 2009 to July 2010.
  
  
  METHODS
  American Society of Anaesthesiology (ASA) physical status (PS) I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 (n=51) received general anaesthesia (GA) and group 2 (n=49) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant.
  
  
  RESULTS
  Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients (29.4%) for pain relief in the postoperative period. Two patients (4.1%) in the EA group required additional analgesic during that period. Eleven patients (21.5%) in the GA group had postoperative vomiting. In the EA group only 1 patient (2%) had postoperative vomiting. Patients in EA group had better postoperative pain relief (p = 0.001) and remained free from vomiting than the GA group (p = 0.003). Thirty six patients (70.5%) of the GA group and 34 patients (69.4%) in the EA group were discharged within 36 hours postoperatively (p = 0.896).
  
  
  CONCLUSIONS
  The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy.
authors.affiliation: Department of Anaesthesia and Intensive Care, Combined Military Hospital (CMH), Skardu. umerzahur@hotmail.com
authors.forename: Muhammad Umar
authors.initials: MU
authors.lastname: Zahoor
authors.forename: Rehan
authors.initials: R
authors.lastname: Masroor
authors.forename: Tassadaq
authors.initials: T
authors.lastname: Khurshid
authors.forename: Raheel
authors.initials: R
authors.lastname: Azhar
authors.forename: Malik Muhammad
authors.initials: MM
authors.lastname: Amjad Yasin
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000768:Anesthesia, General / Q000379:methods; D002763:Cholecystectomy / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D005705:Gallbladder Diseases / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007813:Laparotomy; D007902:Length of Stay / Q000639:trends; D007988:Liberia / Q000453:epidemiology; D008297:Male; D010149:Postoperative Pain / Q000453:epidemiology / Q000517:prevention & control*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology / Q000517:prevention & control*; D012189:Retrospective Studies; D013904:Thoracic Vertebrae; D016896:Treatment Outcome