Spinal anaesthesia versus general anaesthesia for gynecological diagnostic laparoscopy: A retrospective comparative study.

Sunil Kedia; Kedia Ritika

doi:10.51168/zzqsq433

Autori

Sunil Kedia Assistant Professor, Department of Anaesthesiology, Gouri Devi Institute of Medical Sciences and Hospital College, Rajbandh, West Bengal, India
Kedia Ritika Associate Professor, Department of Obstetric And Gynaecology, Gautam Medical College And Hospital,Ranchi, Jharkhand, India

DOI:

https://doi.org/10.51168/zzqsq433

Cuvinte cheie:

Diagnostic laparoscopy, spinal anaesthesia, general anaesthesia, postoperative pain, gynecology, retrospective study

Rezumat

Background

Diagnostic laparoscopy is widely used for evaluating infertility, chronic pelvic pain, adnexal pathology, and other pelvic disorders. General anaesthesia (GA) remains standard, while spinal anaesthesia (SA) may offer advantages in postoperative pain control, reduced postoperative nausea and vomiting (PONV), and faster recovery.

Objective

To compare perioperative outcomes of spinal and general anaesthesia in women undergoing gynecological diagnostic laparoscopy.

Materials and Methods

This retrospective comparative study included 120 women who underwent elective gynecological diagnostic laparoscopy at Gouri Devi Institute of Medical Sciences and Hospital, Rajbandh, West Bengal, between January 2024 and January 2025. Patients were categorized into SA (n=60) and GA (n=60) groups based on hospital records. Demographic, intraoperative, postoperative, recovery, and patient satisfaction outcomes were evaluated.

Results

Mean operative duration was comparable between groups (48.3±11.2 vs 49.5±10.7 minutes, p=0.54). Six-hour postoperative pain scores were significantly lower with SA (2.8±1.1 vs 4.6±1.4, p<0.001). PONV occurred in 8.3% versus 28.3% (p=0.005), and rescue analgesic requirement was 30.0% versus 71.7% (p<0.001) in SA and GA groups, respectively. Recovery room stay was shorter with SA (88.5±18.6 vs 112.4±24.3 minutes, p<0.001), with higher patient satisfaction.

Conclusion

SA was associated with improved postoperative analgesia, reduced PONV and analgesic requirements, and faster recovery compared with GA, with comparable operative outcomes.

Recommendation

SA may be considered an alternative to GA in appropriately selected women undergoing short-duration gynecological diagnostic laparoscopy.

Biografii autori

Sunil Kedia, Assistant Professor, Department of Anaesthesiology, Gouri Devi Institute of Medical Sciences and Hospital College, Rajbandh, West Bengal, India

is an Assistant Professor in the Department of Anaesthesiology at Gouri Devi Institute of Medical Sciences and Hospital, Rajbandh, West Bengal, India. He contributed to the conceptualization, methodology, data collection, analysis, and preparation of this manuscript.
Kedia Ritika, Associate Professor, Department of Obstetric And Gynaecology, Gautam Medical College And Hospital,Ranchi, Jharkhand, India

is an Associate Professor in the Department of Obstetrics and Gynaecology at Gautam Medical College and Hospital, Ranchi, Jharkhand, India. She contributed to the clinical interpretation, literature review, manuscript preparation, and critical revision of the manuscript.

Referințe

1. Bajwa SJ, Kulshrestha A. Anaesthesia for laparoscopic surgery: General vs regional anaesthesia. J Minim Access Surg. 2016;12(1):4-9.

2. Joris JL. Anesthesia for laparoscopic surgery. In: Miller RD, editor. Miller's Anesthesia. 8th ed. Philadelphia: Elsevier; 2015. p. 2185-2202.

3. Sutton C. Practical Manual of Operative Laparoscopy and Hysteroscopy. 3rd ed. London: Informa Healthcare; 2008.

4. White PF, Kehlet H. Improving postoperative pain management: What are the unresolved issues? Anesthesiology. 2010;112(1):220-225.

5. Apfel CC, Korttila K, Abdalla M, Kerger H, Turan A, Vedder I, et al. A factorial trial of six interventions for the prevention of postoperative nausea and vomiting. N Engl J Med. 2004;350(24):2441-2451.

6. Gan TJ. Risk factors for postoperative nausea and vomiting. Anesth Analg. 2006;102(6):1884-1898.

7. Kaya Uğur B, Pirbudak L, Öztürk E, Balat Ö, Uğur MG. Spinal versus general anesthesia in gynecologic laparoscopy: A prospective, randomized study. Turk J Obstet Gynecol. 2020;17(3):186-195.

8. Sinha R, Gurwara AK, Gupta SC. Laparoscopic surgery using spinal anesthesia. JSLS. 2008;12(2):133-138.

9. Imbelloni LE, Grigorio R, Fialho JC, Fornasari M, Pitombo PF. Spinal anesthesia for outpatient laparoscopic procedures: Feasibility and perioperative outcomes. Rev Bras Anestesiol. 2014;64(2):95-102.

10. Lennox PH, Chilvers C, Vaghadia H. Selective spinal anesthesia versus desflurane anesthesia in short-duration outpatient gynecological laparoscopy: A pharmacoeconomic comparison. Anesthesiology. 2002;94(3):565-568.

11. Asgari Z, Rezaeinejad M, Hosseini R, Nataj M, Razavi M, Sepidarkish M. Spinal anesthesia and spinal anesthesia with subdiaphragmatic lidocaine in shoulder pain reduction for gynecological laparoscopic surgery: A randomized clinical trial. Pain Res Manag. 2017;2017:1721460.

12. Della Corte L, Mercorio A, Morra I, Riemma G, De Franciscis P, Palumbo M, et al. Spinal anesthesia versus general anesthesia in gynecological laparoscopic surgery: A systematic review and meta-analysis. Gynecol Obstet Invest. 2022;87(1):1-11.

13. Kehlet H, Wilmore DW. Evidence-based surgical care and the evolution of fast-track surgery. Ann Surg. 2008;248(2):189-198.

14. Imbelloni LE, Fornasari M, Fialho JC, Sant'Anna R, Cordeiro JA. General anesthesia versus spinal anesthesia for laparoscopic cholecystectomy. Rev Bras Anestesiol. 2010;60(3):217-227.

15. Pursnani KG, Bazza Y, Calleja M, Mughal MM. Laparoscopic surgery under spinal anesthesia: A prospective study of feasibility and safety. Surg Endosc. 1998;12(4):362-364.

16. Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal versus general anesthesia for laparoscopic cholecystectomy: Interim analysis of a controlled randomized trial. Arch Surg. 2008;143(5):497-501.

17. White PF. The changing role of non-opioid analgesic techniques in the management of postoperative pain. Anesth Analg. 2005;101(5 Suppl):S5-S22.

18. Kehlet H, Dahl JB. The value of multimodal or balanced analgesia in postoperative pain treatment. Anesth Analg. 1993;77(5):1048-1056.

19. Sinatra R. Causes and consequences of inadequate management of acute pain. Pain Med. 2010;11(12):1859-1871.

20. Pierre S, Whelan R. Nausea and vomiting after surgery. Contin Educ Anaesth Crit Care Pain. 2013;13(1):28-32.

21. Ljungqvist O, Scott M, Fearon KC. Enhanced Recovery After Surgery: A review. JAMA Surg. 2017;152(3):292-298.

22. Van de Velde M, De Buck F. Anesthesia for laparoscopic surgery. Curr Opin Anaesthesiol. 2007;20(3):181-186.

23. Sinha R, Gurwara AK, Gupta SC. Laparoscopic surgery using spinal anesthesia. JSLS. 2008;12(2):133-138.

24. Myles PS, Williams DL, Hendrata M, Anderson H, Weeks AM. Patient satisfaction after anaesthesia and surgery: Results of a prospective survey of 10,811 patients. Br J Anaesth. 2000;84(1):6-10.

25. Wu CL, Naqibuddin M, Fleisher LA. Measurement of patient satisfaction as an outcome of regional anesthesia and analgesia: A systematic review. Reg Anesth Pain Med. 2001;26(3):196-208.

26. Neal JM, Barrington MJ, Brull R, Hadzic A, Hebl JR, Horlocker TT, et al. The second American Society of Regional Anesthesia and Pain Medicine evidence-based medicine assessment of ultrasound-guided regional anesthesia. Reg Anesth Pain Med. 2016;41(2):181-194.

27. Ballantyne JC, Carr DB, deFerranti S, Suarez T, Lau J, Chalmers TC, et al. The comparative effects of postoperative analgesic therapies on pulmonary outcome: Cumulative meta-analyses of randomized, controlled trials. Anesth Analg. 1998;86(3):598-612.

28. Møiniche S, Kehlet H, Dahl JB. A qualitative and quantitative systematic review of pre-emptive analgesia for postoperative pain relief. Anesthesiology. 2002;96(3):725-741.

29. Joshi GP, Kehlet H. Procedure-specific pain management and outcome strategies. Best Pract Res Clin Anaesthesiol. 2014;28(2):191-201.

30. Gupta A, Stierer T, Zuckerman R, Sakima N, Parker SD, Fleisher LA. Comparison of recovery profile after ambulatory anesthesia with propofol, isoflurane, sevoflurane, and desflurane: A systematic review. Anesth Analg. 2004;98(3):632-641.

31. Memtsoudis SG, Poeran J, Cozowicz C, Zubizarreta N, Ozbek U, Mazumdar M, et al. The impact of anesthetic technique on postoperative outcomes in orthopedic surgery. Reg Anesth Pain Med. 2019;44(1):53-58.

32. Macario A, Weinger M, Truong P, Lee M. Which clinical anesthesia outcomes are important to avoid? The perspective of patients. Anesth Analg. 1999;89(3):652-658.

33. Myles PS. Measuring quality of recovery in perioperative clinical trials. Curr Opin Anaesthesiol. 2018;31(4):396-401.

34. Kehlet H. Fast-track surgery—an update on physiological care principles to enhance recovery. Langenbecks Arch Surg. 2011;396(5):585-590.