title: Laparo-endoscopic single-site (LESS) cholecystectomy with epidural vs. general anesthesia.
abstract: BACKGROUND
  Laparo-endoscopic single-site (LESS) surgery involves a single umbilical incision, lending itself to epidural anesthesia. This prospective, randomized study was undertaken to evaluate epidural anesthesia for patients undergoing LESS cholecystectomy, to assess the feasibility, and to analyze all intraoperative and postoperative complications. The secondary objectives were to determine differences in postoperative pain and time until PACU discharge-to-home readiness between patients.
  
  
  METHODS
  With institutional review board approval, 20 patients with chronic cholecystitis, cholelithiasis, and/or biliary dyskinesia were randomized to receive spinal epidural anesthesia (n = 10) or general anesthesia (n = 10). Postoperative pain at rest was recorded in the PACU every 10 min, and at rest and walking at discharge using the visual analog scale (VAS). Operative time and time until PACU discharge-to-home readiness were recorded. Results are expressed as mean ± SD.
  
  
  RESULTS
  Patient age, American Society of Anesthesiologists class, and body mass index were similar. There were no additional ports/incisions, conversions to "open" operations, or conversions to general anesthesia. There were no differences in operative duration. Time until postanesthesia care unit discharge-to-home ready was not significantly different. The most common postoperative adverse event was urinary retention (1 epidural and 3 general anesthesia patients). Resting postoperative VAS pain score at discharge was 4.7 ± 2.5 vs. 2.2 ± 1.6 (p = 0.02, general versus epidural anesthesia respectively); the stressed VAS pain score at discharge was 6.1 ± 2.3 vs. 3.1 ± 2.8 (p = 0.02, general versus epidural anesthesia respectively).
  
  
  CONCLUSIONS
  LESS cholecystectomy with epidural anesthesia was completed with no operative or anesthetic conversions, and less postoperative pain at discharge. Epidural anesthesia appears to be a preferable alternative to general anesthesia for patients undergoing LESS cholecystectomy.
authors.affiliation: Southeastern Center for Digestive Disorders & Pancreatic Cancer, Advanced Minimally Invasive & Robotic Surgery, Florida Hospital Tampa, 3000 Medical Park Drive, Suite #310, Tampa, FL 33613, USA. sharona.ross@yahoo.com
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.forename: Devanand
authors.initials: D
authors.lastname: Mangar
authors.forename: Rachel
authors.initials: R
authors.lastname: Karlnoski
authors.forename: Enrico
authors.initials: E
authors.lastname: Camporesi
authors.forename: Katheryne
authors.initials: K
authors.lastname: Downes
authors.forename: Kenneth
authors.initials: K
authors.lastname: Luberice
authors.forename: Krista
authors.initials: K
authors.lastname: Haines
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural; D000771:Anesthesia, Intravenous; D000779:Anesthetics, Local; D001660:Biliary Tract Diseases / Q000601:surgery*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D005240:Feasibility Studies; D005260:Female; D005283:Fentanyl; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007431:Intraoperative Complications / Q000188:drug therapy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000517:prevention & control; D017060:Patient Satisfaction; D015742:Propofol; D011446:Prospective Studies; D020069:Shoulder Pain / Q000188:drug therapy / Q000209:etiology; D016037:Single-Blind Method; D014472:Umbilicus
chemical_list: D000779:Anesthetics, Local; D006993:Hypnotics and Sedatives; D005283:Fentanyl; D015742:Propofol