Background and Aims Laparoscopy is a procedure requiring total muscular relaxation , traditionally performed under GA Regional anaesthesia provides total analgesia and muscle relaxation with complete preservetion of consciousness and rapid postoperative recovery. Spinal and combined spinal-epidural blocks have been used for laparoscopic general surgery in patients with relevant medical pathologies including coexisting pulmonary disease This study shows the feasability of all types of laparoscopic surgery under CSE , on awake patients
Methods 655 ASA I to III patients between 30 and 80 years old scheduled for different laparoscopic surgery ( cholecystectomy , appendicectomy , colectomy , sigmoidectomy , inguinal hernia , prostatectomy and hysterectomy ) were included in this protocol after informed consent After monitoring preloading and light sedation , with the patient in left lateral decubitus epidural space was identified by the lost of resistance to air technique between L1-L2 A 27G spinal needle was introduced in the subarachnoid space and 20 mg Bupivacaine + 7,5 µg Sufentanil + 4 mg Dexamethasone in a total volume of 5 ml were injected Patients were placed in the Trendelemburg position until sensitif block level at T2 Maximum intraperitoneal pressure didn’t exceed 12 mm Hg
Results 70 patients ( 10,68%) experienced shoulder pain after pneumoperitoneum successfully treated with 0,5 mg iv alfentanil 1 patient required conversion to GA Duration of procedures ranged between 25 and 180 mins
Conclusions RA affords excellent muscle relaxation, total per and postoperative pain relief , rapid discharge . Different studies showed a better outcome in frail and obese patients compared to GA
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