Key result
Spinal anesthesia significantly reduced the probability of vomiting within the first 5 hours post-operation (P < 0.001) and total procedure costs compared to general anesthesia in children undergoing laparoscopic appendectomy.
Why the study?
Does spinal anesthesia improve outcomes and reduce costs compared to general anesthesia in pediatric patients undergoing laparoscopic appendectomy?
Case-Control (n=77)
No
Does spinal anesthesia improve outcomes and reduce costs compared to general anesthesia in pediatric patients undergoing laparoscopic appendectomy?
p-value: p=<0.001
Spinal anesthesia is a safe and cost-effective alternative to general anesthesia for pediatric laparoscopic appendectomies, reducing postoperative vomiting and hospital stay.
Spinal anesthesia was associated with less early vomiting and lower costs; hypothesis-generating and requires randomized trials before practice change.
STRUCTURED ABSTRACT Background Owing to the widespread use of general anesthesia, administration of spinal anesthesia in pediatrics is not widely practiced. Yet there is ample positive evidence demonstrating its safety, effectiveness and success. Objective The objective of this study is to demonstrate that laparoscopic appendectomies are successful under spinal anesthesia and elicit clear advantages over general anesthesia. Methods This was a retrospective analysis of 77 pediatric (5-8 year old) laparoscopic appendectomies that took place in a Hospital in Chittagong, Bangladesh in 2019. Approximately half of the patients underwent spinal anesthesia while the other half underwent general anesthesia. Variables such as surgery and operation theatre times, pain score, incidence of post-surgery vomiting, analgesic usage, discharge times and hospital costs were recorded. Statistical analysis was used to analyze the data as a function of form of anesthesia. Results The probability of vomiting when using spinal compared to general anesthesia was much lower within the first 5 hours (P < .001) and after 6 hours (P = .008) of operation. Highly significant difference (P < .001) was observed in the total costs of the procedures. A significantly higher likelihood of patients being discharged the same day of the procedure was noted if spinal anesthesia was used (P = .008). Conclusions Spinal anesthesia is superior to general anesthesia for pediatric laparoscopic appendectomies. Patient comfort is improved through a significant decrease in vomiting. This enables more rapid hospital discharges and a significant cost saving, without compromising the outcome of the procedure. MINI-ABSTRACT Spinal anesthesia is seldom used for laparoscopy in children. This retrospective case-controlled study compared spinal anesthesia with general anesthesia in children between 5 and 8 years of age. Spinal anesthesia proved to be safer and cost-effective for laparoscopy in children.
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Hannan et al. (2020) conducted a case-control in Pediatric appendicitis requiring laparoscopic appendectomy (n=77). Spinal anesthesia vs. General anesthesia was evaluated on Incidence of vomiting within the first 5 hours post-operation (p=<0.001). Spinal anesthesia significantly reduced the probability of vomiting within the first 5 hours post-operation (P < 0.001) and total procedure costs compared to general anesthesia in children undergoing laparoscopic appendectomy.
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