title: Major laparoscopic surgery under regional anesthesia: A prospective feasibility study.
abstract: BACKGROUND
  Laparoscopic surgeries have attained the status of a gold standard for most of the abdominal pathology; we therefore performed this study to assess feasibility and safety of major laparoscopic surgeries like laparoscopic cholecystectomy (LC) and laparoscopic assisted vaginal hysterectomy (LAVH)/total laparoscopic hysterectomy (TLH) under regional anesthesia that is combined spinal epidural anesthesia (CSE) with normal pressure pneumoperitoneum using intrathecal fentanyl with bupivacain.
  
  
  METHODS
  In a zonal government hospital, 50 patients were selected prospectively for LC and LAVH/TLH, under normal pressure (12 mmHg) pneumoperitoneum and under CSE over a span of fifteen months. Injection bupivacaine (0.5%) and 20 μg of fentanyl were used for spinal anesthesia. Plain bupivacaine (0.5%) was used for epidural anesthesia.
  
  
  RESULTS
  We successfully performed the operations in 48 patients without major complications. CSE was converted to general anesthesia in two patients due to distressing shoulder tip pain. Age varied between 25 and 70 years. Duration of operation time (skin to skin) was between 50 and 170 min. Five patients had urinary retention and one developed localized pruritis. There was no incidence of respiratory depression, aspiration or headache.
  
  
  CONCLUSIONS
  Laparoscopic surgeries with normal pressure CO2 pneumoperitoneum are feasible and safe under CSE. Incidence of postoperative shoulder pain was minimal due to use of intrathecal fentanyl and complications were less and easily manageable.
authors: Senior Adviser (Anaesthesiology), Military Hospital Jaipur, Rajasthan, India.
authors: R K
authors: RK
authors: Singh
authors: Classified Specialist (Anaesthesiology), Military Hospital Jaipur, Rajasthan, India.
authors: A M
authors: AM
authors: Saini
authors: Classified Specialist (Anaesthesiology), 174 Military Hospital, C/O 56 APO, India.
authors: Nitin
authors: N
authors: Goel
authors: Senior Adviser (Surgery), Military Hospital Jaipur, Rajasthan, India.
authors: Dinesh
authors: D
authors: Bisht
authors: Senior Adviser (Obst & Gynae), Military Hospital Jaipur, Rajasthan, India.
authors: Atul
authors: A
authors: Seth
keywords: Combined spinal and epidural anesthesia; General anesthesia; Laparoscopic assisted vaginal hysterectomy; Laparoscopic cholecystectomy; Regional anesthesia; Total laparoscopic hysterectomy