Laparoscopic Cholecystectomy Lower Thoracic Spinal Anesthesia.A retrospective Study with 505 Patients

Abstract

Background: In our group, after a study showing that spinal anesthesia is safe when compared with general anesthesia, spinal anesthesia has been the technique of choice for this procedure. This is a retrospective study with patients undergoing laparoscopic cholecystectomy under thoracic spinal anesthesia.

Methods: A total of 505 laparoscopic cholecystectomy patients operated under spinal anesthesia were included in this study. Spinal anesthesia was between T8 to T11, with a 27G cutting point or pencil tip in lateral or sitting. Spinal anesthesia was performed with two doses of 0.5% bupivacaine hyperbaric plus 25 µg of fentanyl, until reaching the sensitive level of T3. We evaluated the demographics, analgesia, and degree of motor block, incidence of paresthesia,bradycardia, hypotension, anesthesia success and neurological complications.

Results: All 505 patients developed spinal. Neither the dose of hyperbaric solution of 0.5% bupivacaine nor the addition of fentanyl affected the onset of sensory block. The duration of sensory block was greater than the motor block with hyperbaric solution. Bradycardia occurred in 16 (3.1%) patients, and was not correlated with the level of thoracic puncture. Hypotension occurred in 82 (16.2%), with no significant association with the dose of local anesthetic.None of the 505 patients had the maximum degree of lower limb motor block, with significant difference in terms of dose. Paresthesia was observed in 28 (5.5%) without significant difference between needles. All paresthesias were transient and without residual sequelae.

Conclusion: The beginning of the block is fast regardless of the solution used. By providing a sensory block of longer duration than the motor block hyperbaric bupivacaine is reflected in a better indication. Thoracic spinal anesthesia provides excellent anesthesia for lower limb orthopedic surgery, without neurological sequelae.