SELECTIVE SPINAL ANAESTHESIA AS PREEMPTIVE ANALGESIA IN LAPAROSCOPIC CHOLECYSTECTOMY

Abstract

Some patients still experience considerable pain and discomfort during first 24 hours after laparoscopic cholecystectomy. About 30-40% of discharged patients may suffer from moderate to severe pain which affected stress response and prolonged the time of stay. Objective: the aim of study was to compare general anesthesia(GA) routine technique and selective spinal anesthesia(SSA) which used preoperative on the basis of preemptive analgesia before GA and study the efficacy on postoperative pain and stress response. Methods: Randomized control study enrolled 40 patients were divided into two groups, GA (control group) received GA only and SSA group received SSA before GA, 20 patients of each. Intraoperative hemodynamic were recorded. Postoperative pain scores, cumulative doses of pethidine requirements over 24 hrs, sedation scores, urinary retention, nausea, vomiting, Pruritus, and Post Dural Puncture Headache were recorded. Blood cortisol and glucose level were checked one hour preoperative and 3hours after surgery for stress response to pain. Results: postoperative pain score was no significant in control group compared to SSA group (p > 0.05) even pain score was less in SSA group in 1st hour with high significant p value < 0.001 and no opiates needed in SSA group. Preoperative and postoperative plasma cortisol levels increased in GA group and decreased in SSA group with high significant value ( p< 0.001) but plasma glucose level was no significant preoperatively in both groups and decreased postoperative in SSA group less than GA group with high significant (p < 0.001). No significant differences in other postoperative parameters and in intraoperative hemodynamic between both groups by (p > 0.05). Conclusion: The study showed that SSA in preoperative as preemptive provided postoperative analgesia, reduced the stress response to pain while maintaining better hemodynamic stability with fewer side effects and no opiates requirements were needed.