SEGMENTAL THORACIC SPINAL ANAESTHESIA FOR CHOLECYSTECTOMY - A CLINICAL TRIAL

AIM OF STUDY: Cholecystectomy is generally performed under general anaesthesia but regional anaesthesia has been found beneficial, especially in patients with major medical problems. The objective of this study was to evaluate the effectiveness of segmental spinal anaesthesia in cholecystectomy so that it can be later used in patients when general anaesthesia is not feasible. MATERIALS AND METHODS : Twenty patients of ASA I and II of either sex undergoing elective cholecystectomy received a segmental spinal anaesthesia at 10 th thoracic interspace (T 10 - T11 ) using 1.0 ml bupivacaine heavy (5 mgml -1) mixed with 0.5 ml fentanyl (25 μg). An epidural catheter was placed in the same space. Intraoperative haemodynamic parameters were monitored. Systemic drugs were administered if patients complained of pain, anxiety, hypotension, nausea or pruritus during or after surgery. RESULTS : The block was effective for surgery in all patients except two who required epidural top up. Four patients required midazolam for anxiety and five required mephenteramine for hypotension at two minutes after spinal injection, otherwise haemodynamics and respiratory parameters were within physiological limits. Twelve patients complained of mild pruritus around face and neck which did not require any treatment. Fifteen patients were able to ambulate after surgery. There was good surgeon and patients' satisfaction. CONCLUSION : Segmental Spinal Anaesthesia with bupivacaine and fentanyl could be a safe and effective alternative anaesthetic regime for cholecystectomy. However this technique requires great caution as the needle is inserted above the level of termination of the spinal cord and more studies with more number of cases are required befor advocating this technique.