Laparoscopic cholecystectomy under segmental thoracic spinal anaesthesia: a feasibility study

Background: Laparoscopic surgery is normally performed under general anaesthesia,but regional techniques have been found beneficial, usuallyin the management of patients with major medical problems. Encouragedby such experience, we performed a feasibility study of segmentalspinal anaesthesia in healthy patients. Methods: Twenty ASA I or II patients undergoing elective laparoscopiccholecystectomy received a segmental (T10 injection) spinalanaesthetic using 1 ml of bupivacaine 5 mg ml^–1 mixedwith 0.5 ml of sufentanil 5 µg ml^–1. Other drugswere only given (systemically) to manage patient anxiety, pain,nausea, hypotension, or pruritus during or after surgery. Thepatients were reviewed 3 days postoperatively by telephone. Results: The spinal anaesthetic was performed easily in all patients,although one complained of paraesthesiae which responded toslight needle withdrawal. The block was effective for surgeryin all 20 patients, six experiencing some discomfort which wasreadily treated with small doses of fentanyl, but none requiringconversion to general anaesthesia. Two patients required midazolamfor anxiety and two ephedrine for hypotension. Recovery wasuneventful and without sequelae, only three patients (all forsurgical reasons) not being discharged home on the day of operation. Conclusions: This preliminary study has shown that segmental spinal anaesthesiacan be used successfully and effectively for laparoscopic surgeryin healthy patients. However, the use of an anaesthetic techniqueinvolving needle insertion into the vertebral canal above thelevel of termination of the spinal cord requires great cautionand should be restricted in application until much larger numbersof patients have been studied.