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BJA Advance Access published online on March 19, 2007
British Journal of Anaesthesia, doi:10.1093/bja/aem058
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study

A. A. J. van Zundert1,*, G. Stultiens2, J. J. Jakimowicz2, D. Peek1, W. G. J. M. van der Ham1, H. H. M. Korsten1 and J. A. W. Wildsmith3

1 Department of Anesthesiology, ICU and Pain Therapy
2 Department of Surgery, Catharina Hospital–Brabant Medical School, Michelangelolaan 2, NL-5623 EJ Eindhoven, The Netherlands
3 Department of Anaesthesia, Ninewills Hospital and Medical School, Dundee DD1 9SY, UK

* Corresponding author. E-mail: zundert{at}iae.nl

Background: Laparoscopic surgery is normally performed under general anaesthesia, but regional techniques have been found beneficial, usually in the management of patients with major medical problems. Encouraged by such experience, we performed a feasibility study of segmental spinal anaesthesia in healthy patients.

Methods: Twenty ASA I or II patients undergoing elective laparoscopic cholecystectomy received a segmental (T10 injection) spinal anaesthetic using 1 ml of bupivacaine 5 mg ml–1 mixed with 0.5 ml of sufentanil 5 µg ml–1. Other drugs were only given (systemically) to manage patient anxiety, pain, nausea, hypotension, or pruritus during or after surgery. The patients were reviewed 3 days postoperatively by telephone.

Results: The spinal anaesthetic was performed easily in all patients, although one complained of paraesthesiae which responded to slight needle withdrawal. The block was effective for surgery in all 20 patients, six experiencing some discomfort which was readily treated with small doses of fentanyl, but none requiring conversion to general anaesthesia. Two patients required midazolam for anxiety and two ephedrine for hypotension. Recovery was uneventful and without sequelae, only three patients (all for surgical reasons) not being discharged home on the day of operation.

Conclusions: This preliminary study has shown that segmental spinal anaesthesia can be used successfully and effectively for laparoscopic surgery in healthy patients. However, the use of an anaesthetic technique involving needle insertion into the vertebral canal above the level of termination of the spinal cord requires great caution and should be restricted in application until much larger numbers of patients have been studied.

Keywords: anaesthesia, day-case; anaesthetic techniques, regional, spinal; anaesthetics local, bupivacaine; analgesics opioid, sufentanil; surgery, laparoscopic cholecystectomy


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E-letters:

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Laparoscopic cholesystectomy under spinal anesthesia
George Tzovaras, et al.
British Journal of Anaesthesia, 18 Jun 2007 [Full text]
Re: Laparoscopic cholesystectomy under spinal anesthesia
iftikhar ahmed
British Journal of Anaesthesia, 20 Jun 2007 [Full text]
Reply Letter
Andre VAN ZUNDERT, et al.
British Journal of Anaesthesia, 14 Aug 2007 [Full text]

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