title: Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study.
abstract: OBJECTIVE
  Laparoscopic appendectomy (LA) is routinely performed under general, not regional anesthesia. This study assessed the feasibility, efficacy, and side effects of combined spinal-epidural anesthesia (CSEA) in LA.
  
  
  METHODS
  Thirty-three American Society of Anesthesiologist (ASA) physical status classification grade I patients underwent LA under CSEA. CSEA was performed using the needle-through-needle technique at the L3-L4interspace. Preoperative and postoperative adverse events related to CSEA, patient satisfaction, and postoperative pain levels were recorded.
  
  
  RESULTS
  LA under CSEA was performed successfully in 33 patients (84.6%). Peroperatively, right shoulder pain was observed in 8 patients (24.1%), abdominal discomfort in 6 (18.2%), anxiety in 5 (15.2%), hypotension in 2 (6.1%) and nausea-vomiting in 1 (3%). In the first 24 hours after LA, headache, urinary retention, right shoulder pain, and postoperative nausea/vomiting (PONV) occurred in 18.1%, 12.1%, 9.1%, and 0% of patients, respectively. In the first 6 hours postoperation, no patients had operation-site pain that required analgesic treatment. Thirty-one patients (94%) evaluated their satisfaction with the procedure as good or moderate.
  
  
  CONCLUSIONS
  CSEA is an efficient and suitable anesthesia technique in LA for ASA physical status classification grade I healthy patients. CSEA is associated with good postoperative pain control and the absence of PONV and intubation-associated complications.
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, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Turgut
authors.initials: T
authors.lastname: Donmez
authors.affiliation: Department of Anesthesiology and Reanimation, Lütfiye Nuri Burat State Hospital, Istanbul, Turkey.
authors.forename: Vuslat Muslu
authors.initials: VM
authors.lastname: Erdem
authors.affiliation: Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Adnan
authors.initials: A
authors.lastname: Hut
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, Haseki Training and Research Hospital, Istanbul, Turkey.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Akinci
keywords: Appendicitis; Epidural anesthesia; Laparoscopy; Spinal anesthesia