Spinal versus general anesthesia for day-case laparoscopic cholecystectomy: a prospective randomized study.
BACKGROUND
The aim of this study was to compare the surgical outcome of day-case laparoscopic cholecystectomy (DCLC) performed with the patient under spinal anesthesia with that performed with the patients under general anesthesia in the management of symptomatic uncomplicated gallstone disease.


METHODS
One hundred eighty patients were prospectively randomized to either the spinal anesthesia DCLC group (SA-DCLC group) or the general anesthesia DCLC group (GA-DCLC group). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. The incidences of both overnight stay and readmissions were also recorded. Patient satisfaction values as to the anesthetic technique and same-day discharge were assessed by direct questionnaire at the end of the first postoperative week.


RESULTS
In both groups, all procedures were completed laparoscopically. In the SA-DCLC group, there were 4 (4.4%) anesthetic conversions due to intolerable right shoulder pain, and those 4 patients were excluded from further analysis. In the SA-DCLC group, all patients were discharged on the same day. Overnight stay was required in 8 patients (8.9%) in the GA-DCLC group (P<.001). The cause of overnight stay was nausea and vomiting in 4 patients (4.4%), inadequate pain control in 3 patients (3.3%), and unexplained hypotension in 1 patient (1.1%). Readmission was required in 1 patient (1.1%) in the GA-DCLC group. The difference in patient satisfaction scores with regard to both anesthetic technique and same-day discharge was not statistically significant between the two groups studied.


CONCLUSIONS
DCLC performed with the patient under spinal anesthesia is feasible and safe and is associated with less postoperative pain and lower incidence of postoperative nausea and vomiting and therefore a lower incidence of overnight stay compared with that performed with the patient under general anesthesia.
Department of General Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt. samerbessa@gmail.com
Samer S
SS
Bessa
Khaled M
KM
Katri
Wael N
WN
Abdel-Salam
El-Saed A
el-SA
El-Kayal
Tarek A
TA
Tawfik
D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care; D000768:Anesthesia, General; D000775:Anesthesia, Spinal; D017081:Cholecystectomy, Laparoscopic; D004534:Egypt; D005260:Female; D042882:Gallstones / Q000601:surgery*; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010359:Patient Readmission / Q000706:statistics & numerical data; D017060:Patient Satisfaction; D011183:Postoperative Complications; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome