Laparoscopic Cholecystectomy under Spinal Anesthesia with Conscious Sedation – A Prospective Randomized Study

Background: General anesthesia is the anesthetic technique of choice for laparoscopic cholecystectomy. Spinal anesthesia has become the primary choice for laparoscopic cases due to advantages such as complete relaxation of muscles, conscious state, economical, uneventful postoperative recovery, and painless early period postoperatively and reduced complications associated with general anesthesia. The present study aimed to study the effects of laparoscopic cholecystectomy under spinal anesthesia. Materials and Methods: Following approval from the institutional ethical committee, 225 patients (males = 57 and females = 168) with age ranging between 19 and 85 years were selected for the study. 0.5% bupivacaine (15–170 mg) using 25G spinal needles was used for administering a neuraxial block in L3–L4 space. After a neuraxial block, the head was kept at a low-steep position, and a 0.3 mg injection of atropine with 15 mg of injection ephedrine was given. After completing the laparoscopic procedure, patient was placed in head up and right up position. As CO 2 pneumoperitoneum was achieved, 2 ml of conscious sedative agents injection midazolam 1.5 mg (1.5 ml) along with ketamine 2.5 mg (0.5 ml) and injection butorphanol 2 mg (2 ml) were administered for reducing abdominal discomfort and shoulder pain or irritation. Injection pantoprazole 40 mg and injection ondansetron 4 mg were given preoperatively for reducing risk of vomiting and aspiration. Results: The subjects comprised 52.63% of males and 60.71% of females aged <50 years, while 47.37% were males and 39.29% were females over 50 years. 8.77% of males and 52.38% of females were <160 cm in height, whereas 91.33% of males and 47.62% of females were more than 160 cm in height; 74.54% of males and 40.47% of females were <70 kg in weight, while 82.46% of males and 59.33% of females weighed over 70 kg. 26.13% of males and 47.61% of females had history of previous performed surgeries other than cholecystectomy. Surgical time taken in males were 58 min, whereas in females, it was 35 min. 17.54% of males and 34.52% of females had shoulder pain, whereas none of the patients had nausea or vomiting episodes. 26.31% of males and 22.61% of females suffered from hypotension. 3.5% of males and 1.19% of females had high spinal. Conclusion: Cholecystectomy through laparoscopy is slowly gaining popularity due to various advantages which include early mobilization, reduced morbidity, lesser postoperative pain, and fewer complications.