title: Efficacy of thoracic epidural anesthesia for laparoscopic cholecystectomy.
abstract: BACKGROUND
  Laparoscopic cholecystectomy is performed to minimize the postoperative morbidity and early return to work. This study was planned to evaluate the efficacy and feasibility of thoracic epidural anesthesia for laparoscopic cholecystectomy, so that it can be later used as anesthetic technique in patients when general anesthesia is not feasible.
  
  
  METHODS
  Forty-eight adult consented patients of ASA grade I and II of either sex scheduled for elective laparoscopic cholecystectomy were enrolled for thoracic epidural anesthesia with 15 ml of 0.75% ropivacaine and 50 μg fentanyl. Intraoperative hemodynamic parameters and respiratory efficiency were recorded. Intra-operatively patient anxiety, pain, vomiting, hypotension or any other adverse event was managed with appropriate drug regime. Postoperative pain management with epidural analgesia, and bowel recovery were also recorded.
  
  
  RESULTS
  The thoracic epidural anesthesia was effective for laparoscopic cholecystectomy in all except in two patients where conversion to general anesthesia was required. The hemodynamic parameters and respiratory efficiency were maintained within physiological limits. Only 4 patients required treatment for hypotension with vasopressor and 15 patients experienced shoulder pain, which was effectively managed with small doses of ketamine. The midazolam was required only in 11 patients for anxiety. The mean surgical time was 56.8±51.6 min. The 24-hour postoperative epidural infusion for analgesia was effective with limited effects on bowel and bladder function. Postoperatively only 3 patients had an episode of vomiting. There was good surgeon and patient's satisfaction.
  
  
  CONCLUSIONS
  The thoracic epidural anesthesia with 0.75% ropivacaine and fentanyl for elective laparoscopic cholecystectomy is efficacious and has preserved ventilation and hemodynamic changes within physiological limits during pneumoperitoneum with minimal treatable side effects.
authors.affiliation: Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Amit
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Kumkum
authors.initials: K
authors.lastname: Gupta
authors.affiliation: Department of Radio-diagnosis, Imaging and Interventional Radiology, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Prashant K
authors.initials: PK
authors.lastname: Gupta
authors.affiliation: Department of Surgery, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Nivesh
authors.initials: N
authors.lastname: Agarwal
authors.affiliation: Department of Anaesthesiology and Critical Care, N. S. C. B. Subharti Medical College, Subhartipuram, NH-58, Meerut, Uttar Pradesh, India.
authors.forename: Bhawna
authors.initials: B
authors.lastname: Rastogi
keywords: Epidural anesthesia; fentanyl; laparoscopic cholecystectomy; pneumoperitoneum; ropivacaine