Laparoscopic Cholecystectomy Under Combined Spinal/Epidural Anesthesia: A Retrospective Analysis of 112 Cases in Terms of Per- and Postoperative Outcomes

Sunamak, O�uzhan; Donmez, Turgut; Uzman, Sinan; Erdem, Vuslat Muslu; Erdem, Duygu Ayfer; Y�ld�r�m, Do�an; Hut, Adnan; Avaro�lu, H�seyin �mam; Ak�nc�, Muzaffer

Laparoscopic Endoscopic Surgical Science Laparoscopic Cholecystectomy Under Combined Spinal/Epidural Anesthesia: A Retrospective Analysis of 112 Cases in Terms of Per- and Postoperative Outcomes [Haydarpasa Numune Med J]

Haydarpasa Numune Med J. 2018; 58(1): 5-11 | DOI: 10.14744/hnhj.2017.60783

Laparoscopic Cholecystectomy Under Combined Spinal/Epidural Anesthesia: A Retrospective Analysis of 112 Cases in Terms of Per- and Postoperative Outcomes

O�uzhan Sunamak¹, Turgut Donmez², Sinan Uzman³, Vuslat Muslu Erdem⁴, Duygu Ayfer Erdem⁴, Do�an Y�ld�r�m⁵, Adnan Hut⁵, H�seyin �mam Avaro�lu², Muzaffer Ak�nc�⁵
¹Department of General Surgery, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
²Department of General Surgery, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
³Department of Anesthesiology and Reanimation, Haseki Training and Research Hospital, Istanbul, Turkey
⁴Department of Anesthesiology and Reanimation, Lutfiye Nuri Burat State Hospital, Istanbul, Turkey
⁵Department of General Surgery, Haseki Training and Research Hospital, Istanbul, Turkey

INTRODUCTION: Laparoscopic cholecystectomy (LC) is the gold standard for the treatment of benign gall bladder diseases. The use of spinal (SA), epidural (EA), and combined spinal epidural anesthesia (CSEA) has increased in recent years.
METHODS: A total of 112 patients who underwent elective LC under CSEA for gall stones or polyps were retrospectively analyzed. Low-pressure CO2 pneumoperitoneum was used, and standard LC was performed. Patient demographics, ASA scores, comorbidities, surgery, anesthesia, and total time were recorded. Intraoperative complications (hypotension, bradycardia, hypoxemia, nausea/vomiting, right shoulder pain, anxiety or abdominal discomfort, and/or pain) were recorded. Postoperative shoulder pain, postdural puncture headache (PDPH), nausea/vomiting, urinary retention, anxiety, and abdominal discomfort and/or pain were also recorded.
RESULTS: LC was successful in all patients, except one. Seventy patients had VAS0=0, 40 (35.7%) had VAS0 <1, and two (1.8%) had VAS0 ≤2. The patient satisfaction score was 4 or 5 for 84.8% of patients. There was intraoperative abdominal discomfort, shoulder pain, and anxiety in 26 (23.2%), 13 (11.6%), and eight (7.1%) patients, respectively. Two patients (1.8%) developed intraoperative hypotension. Postoperatively, shoulder pain, urinary retention, nausea and vomiting, and PDPH were observed in 10 (8.9%), six (5.4%), four (3.6%), and four (3.6%) patients, respectively.
DISCUSSION AND CONCLUSION: LC under CSEA with low-pressure CO2 pneumoperitoneum is feasible and safe.

Keywords: Anesthesia, laparoscopic cholecystectomy; pain.

Kombine spinal/ epidural anestezi alt�nda laparoskopik kolesistektomi: 112 vakan�n retrospektif incelenmesi per ve post operatif prognoz

O�uzhan Sunamak¹, Turgut Donmez², Sinan Uzman³, Vuslat Muslu Erdem⁴, Duygu Ayfer Erdem⁴, Do�an Y�ld�r�m⁵, Adnan Hut⁵, H�seyin �mam Avaro�lu², Muzaffer Ak�nc�⁵
¹Haydarpa�a Numune E�itim ve Ara�t�rma Hastanesi Genel Cerrehi Klini�i, �stanbul
²Lutfiye Nuri Burat Devlet Hastanesi Genel Cerrehi Klini�i, Istanbul
³Haseki E�itim ve Ara�t�rma Hastanesi Anesteziyoloji ve Reanimasyon Klini�i, �stanbul
⁴Lutfiye Nuri Burat Devlet Hastanesi Anesteziyoloji ve Reanimasyon Klini�i, Istanbul
⁵Haseki E�itim ve Ara�t�rma Hastanesi Genel Cerrehi Klini�i, �stanbul

G�R�� ve AMA�: Laparoskopik kolesistektomi (LC), selim safra kesesi hastal�klar�n�n tedavisinde alt�n standartt�r. Son y�llarda spinal (SA), epidural (EA) ve kombine spinal epidural anestezi (CSEA) alt�nda da yap�lmaktad�r.
Y�NTEM ve GERE�LER: Safra ta�� veya polip i�in LC yap�lan 112 hasta retrospektif incelendi. Hastalarda d��k bas�n�l� CO2 pn�moperitoneum kullan�ld� ve standart LC uyguland�. Hasta �zellikleri, ASA skoru, e�lik eden hastal�klar, cerrahi, anestezi ve toplam s�re kaydedildi. �ntraoperatif komplikasyonlar (hipotansiyon, bradikardi, hipoksemi, bulant�-kusma, sa� omuz a�r�s�, kayg� veya kar�n rahats�zl��, a�r�) kaydedildi. Postoperatif omuz a�r�s�, dural ponksiyon sonras� ba� a�r�s� (PDPH), bulant� / kusma, �riner retansiyon, anksiyete ve abdominal rahats�zl�k ve a�r� kaydedildi.
BULGULAR: LC, bir hasta d��nda hepsinde ba�ar�yla tamamland�. Yetmi� hastada VAS0 = 0, 40 hastada (% 35.7) VAS0 <1 ve 2 hastada (% 1.8) VAS0≤2 idi. Hastalar�n% 84.8'inde hasta memnuniyeti skoru 4 veya 5 bulundu. �ntraperatif abdominal rahats�zl�k, omuz a�r�s� ve anksiyete s�ras�yla 26 (% 23.2), 13 (% 11.6) ve 8 (% 7.1) hastada g�r�ld�. �ki hastada (% 1.8) intraoperatif hipotansiyon geli�ti. Postoperatif olarak omuz a�r�s�, �riner retansiyon, post-operatif bulant�-kusma ve PDPH, s�ras�yla, 10 (% 8.9), 6 (% 5.4), 4 (% 3.6) ve 4 (% 3.6) hastada saptand�.
TARTI�MA ve SONU�: D��k bas�n�l� CO2 pn�moperitoneum alt�nda, CSEA ile LC uygulanabilir ve g�venlidir.

Anahtar Kelimeler: Anestezi, laparoskopik kolesistektomi, a�r�

O�uzhan Sunamak, Turgut Donmez, Sinan Uzman, Vuslat Muslu Erdem, Duygu Ayfer Erdem, Do�an Y�ld�r�m, Adnan Hut, H�seyin �mam Avaro�lu, Muzaffer Ak�nc�. Laparoscopic Cholecystectomy Under Combined Spinal/Epidural Anesthesia: A Retrospective Analysis of 112 Cases in Terms of Per- and Postoperative Outcomes. Haydarpasa Numune Med J. 2018; 58(1): 5-11

Corresponding Author: O�uzhan Sunamak, T�rkiye
Manuscript Language: English

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