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Effectiveness and Safety of Combined Epidural and General Anesthesia for Laparoscopic Cholecystectomy
  1. M. Luchetti, M.D.,
  2. R. Palomba, M.D.,
  3. G. Sica, M.D.,
  4. G. Massa, M.D. and
  5. R. Tufano, M.D.
  1. University of Naples, Federico II Institute of Anesthesiology and Intensive Care, Via Sergio Pansini no. 5, 80131 Naples, Italy
  1. Reprint requests: Marco Luchetti, M.D., Via Mario De Ciccio 18, 80127 Napoli, Italy.


Background and Objectives The aim of this study was to compare the efficacy and safety of two anesthesia techniques, combined epidural/general anesthesia (CEGA) versus total intravenous anesthesia (TIVA), for laparoscopic cholecystectomy.

Methods Forty patients were randomly assigned to one of two different groups: group A received TIVA and group B received CEGA. At preset times during the operation, systolic and diastolic arterial pressure, heart rate, oxygen saturation (SaO2) and end-tidal carbon dioxide (Etco2) were monitored. Postoperatively, recovery (Steward's test) and analgesia (visual analog scale [VAS] pain scores) were assessed, as well as the incidence of adverse effects.

Results The groups were comparable as to demographic data and duration of surgery and of anesthesia. Intraoperative parameters also showed no statistical differences. Both groups had a rapid recovery (Steward score of 6 within 12 minutes), but group B showed better recovery scores at 4 minutes. Postoperative pain was well controlled in both groups, but group B exhibited better scores at postoperative hour 2. The incidence of postoperative side effects was low in both groups.

Conclusions The use of CEGA for laparoscopic cholecystectomy seems to be effective and safe and to offer some advantages as compared to TIVA alone. CEGA can control pain due to CO2-induced peritoneal irritation, providing excellent intra- and postoperative analgesia. CEGA does not require the use of intraoperative intravenous opioids and shortens recovery time, without increasing the incidence of side effects.

  • epidural
  • anesthesia
  • postoperative pain
  • postoperative analgesia
  • laparoscopic surgery

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  • Presented in part at the Twelfth Annual European Society of Regional Anesthesia Congress, Dublin, 1993.