Ann Surg Treat Res.  2017 Apr;92(4):208-213. 10.4174/astr.2017.92.4.208.

Combined spinal-epidural anesthesia in laparoscopic appendectomy: a prospective feasibility study

• Uzman S
• Donmez T
• Erdem VM
• Hut A
• Yildirim D
• Akinci M

• KMID: 2374686
• DOI: http://doi.org/10.4174/astr.2017.92.4.208

Abstract

PURPOSE
Laparoscopic appendectomy (LA) is routinely performed under general, not regional anesthesia. This study assessed the feasibility, efficacy, and side effects of combined spinal-epidural anesthesia (CSEA) in LA.
METHODS
Thirty-three American Society of Anesthesiologist (ASA) physical status classification grade I patients underwent LA under CSEA. CSEA was performed using the needle-through-needle technique at the L₃-L₄ interspace. Preoperative and postoperative adverse events related to CSEA, patient satisfaction, and postoperative pain levels were recorded.
RESULTS
LA under CSEA was performed successfully in 33 patients (84.6%). Peroperatively, right shoulder pain was observed in 8 patients (24.1%), abdominal discomfort in 6 (18.2%), anxiety in 5 (15.2%), hypotension in 2 (6.1%) and nausea-vomiting in 1 (3%). In the first 24 hours after LA, headache, urinary retention, right shoulder pain, and postoperative nausea/vomiting (PONV) occurred in 18.1%, 12.1%, 9.1%, and 0% of patients, respectively. In the first 6 hours postoperation, no patients had operation-site pain that required analgesic treatment. Thirty-one patients (94%) evaluated their satisfaction with the procedure as good or moderate.
CONCLUSION
CSEA is an efficient and suitable anesthesia technique in LA for ASA physical status classification grade I healthy patients. CSEA is associated with good postoperative pain control and the absence of PONV and intubation-associated complications.

Keyword

Laparoscopy; Spinal anesthesia; Epidural anesthesia; Appendicitis

MeSH Terms

Anesthesia*
Anesthesia, Conduction
Anesthesia, Epidural
Anesthesia, Spinal
Anxiety
Appendectomy*
Appendicitis
Classification
Feasibility Studies*
Headache
Humans
Hypotension
Laparoscopy
Pain, Postoperative
Patient Satisfaction
Postoperative Nausea and Vomiting
Prospective Studies*
Shoulder Pain
Urinary Retention

Figure

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  Fig. 1 Flowchart of the study. CSEA, combined spinal/epidural anesthesia.

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