title: Laparoscopic cholecystectomy under spinal-epidural anesthesiavs. general anaesthesia: a prospective randomised study.
abstract: OBJECTIVE
  Laparoscopic cholecystectomy (LC) is usually performed under the general anesthesia (GA). Aim of the study is to investigate the availability, safety and side effects of combined spinal/epidural anesthesia (CSEA) and comparison it with GA for LC.
  
  
  METHODS
  Forty-nine patients who have a LC plan were included into the study. The patients were randomly divided into GA (n = 25) and CSEA (n = 24) groups. Intraoperative and postoperative adverse events, postoperative pain levels were compared between groups.
  
  
  RESULTS
  Anesthesia procedures and surgeries for all patients were successfully completed. After the organization of pneumoperitoneum in CSEA group, 3 patients suffered from shoulder pain (12.5%) and 4 patients suffered from abdominal discomfort (16.6%). All these complaints were recovered with IV fentanyl administration. Only 1 patient developed hypotension which is recovered with fluid replacement and no need to use vasopressor treatment. Postoperative shoulder pain was significantly less observed in CSEA group (25%vs. 60%). Incidence of postoperative nausea and vomiting (PONV) was less observed in CSEA group but not statistically significant (4.2%vs. 20%). In the group of CSEA, 3 patients suffered from urinary retention (12.5%) and 2 patients suffered from spinal headache (8.3%). All postoperative pain parameters except 6th hour, were less observed in CSEA group, less VAS scores and less need to analgesic treatment in CSEA group comparing with GA group.
  
  
  CONCLUSIONS
  CSEA can be used safely for laparoscopic cholecystectomies. Less postoperative surgical field pain, shoulder pain and PONV are the advantages of CSEA compared to GA.
authors.affiliation: Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Donmez
authors.affiliation: Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat Goverment Hospital, Istanbul, Turkey.
authors.forename: Vuslat Muslu
authors.initials: VM
authors.lastname: Erdem
authors.affiliation: Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Sinan
authors.initials: S
authors.lastname: Uzman
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Dogan
authors.initials: D
authors.lastname: Yildirim
authors.affiliation: Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Huseyin
authors.initials: H
authors.lastname: Avaroglu
authors.affiliation: Department of General Surgery, Cerrahpasa Medicine Faculty, Istanbul University, Istanbul, Turkey.
authors.forename: Sina
authors.initials: S
authors.lastname: Ferahman
authors.affiliation: Department of General Surgery, Haydapasa Numune Training and Research Hospital, Istanbul, Turkey.
authors.forename: Oguzhan
authors.initials: O
authors.lastname: Sunamak
keywords: Epidural anesthesia; General anesthesia; Laparoscopic cholecystectomy; Spinal anesthesia