Gallstones disease is one of the most common problems seen in surgical OPD requiring laparoscopic cholecystectomy in symptomatic patients. Routinely all laparoscopic surgeries are performed safely under general anesthesia, and practice of using spinal anesthesia is very less as most of patients experience shoulder discomfort. To alleviate the shoulder discomfort use of intravenous sedation can be implemented.
Aims and Objectives: To perform Laparoscopic cholecystectomy safely under spinal anesthesia with i.v sedation for symptomatic gallstones diseases, and to assess the analgesic effect of the procedure in the early post-operative period, Safe completion of surgery and operative time and inoperative events.
Materials and Methodology: It is a prospective observational study where in 50 patients who presented with biliary colic meeting the inclusion criteria were enrolled. All patients underwent hematological and biochemical investigations, appropriate investigation (LFT, USG, and chest x ray, CT scan / MRCP if needed) were performed based on clinical suspicion. All patients underwent pre-anesthetic evaluation and patients belonging to ASA grade 1 and 2 were taken up for surgery under standard lumbar spinal anesthesia technique with additional intravenous ketamine as sedation.
Results: Spinal anesthesia with i.v sedation was adequate for surgery in all the 50 patients (100%) with none of patients requiring to convert to general anesthesia (100%) Intraoperatively two out of fifty (4%) patients experienced right shoulder pain. Two patients (4%) were given Midazolam for anxiety and one (2%) was given Ephedrine for hypo tension. One patient (2%) had desaturation for which high oxygen was given. Operative difficulty scores were minimal and none of them requiring to convert for open cholecystectomy (100%). Post operatively pain scores were minimal and four patients demanded opioid (20%). One patient (2%) required anti-emetic for vomiting and no patient suffered headache (0%) and urinary retention (0%). 34 patients (68%) were discharged within 24 hours of surgery and patient satisfaction scores were very good.
Conclusion: This study suggest that laparoscopic cholecystectomy can be performed safely under spinal anesthesia with intravenous sedation in ASA grade 1&2 patients providing good analgesia and muscle relaxation in intra operative period and post-operative analgesia and helps in early recovery.