Table of Content Volume 9 Issue 1 - January 2019

 

A study of patient’s satisfaction and various complications occurred during spinal anesthesia used for laparoscopic apendicectomy

 

Abhijeet Kumar Sharma^1*, Santosh Kumar², Ajeet Kumar³

 

Abstract               Background: Laparoscopic appendicectomy (LA) is the most commonly performed intra-abdominal operation. Aims and Objectives: To study patient’s satisfaction and various complications occurred during spinal anesthesia used for laparoscopic apendicectomy. Methodology: This was a cross sectional study carried out in the department of Anesthesiology of a tertiary health care during the one-year period i.e. January 2017 to January 2018 in the patients undergone spinal anesthesia for the laparoscopic appnediscecomy, during the one year after written consent 66 patients were included into the study. The patients satisfaction was noted as fully satisfied, Partly Satisfied, Not satisfied. The data is presented in Tabular form and expressed in percentages. Result: In our study we have seen that The majority of the patients were in the age group of in the age group of 30-40 were 31.82%, 40 -50 were 28.79%, 20-30 were 18.18%, 50-60 were 13.64%, and andgt;60 were 7.58%. The majority of the patients were Male i.e. 57.58% and Female were 42.42%. The most common complications were Nausea and vomiting in 31.82%, followed by Post-dural-puncture headache in 25.76, Urinary retention in 13.64%, Transient neurological symptoms in 7.58%, Mild hypotension in 4.55%, Bradycardia in 3.03%, lower back pain with pain in the legs in 3.03%. The majority of the patients were satisfied i.e. 68.18% were Fully satisfied, 18.18 % were Partly Satisfied, 13.64% Not satisfied. Conclusion: It can be concluded from our study that the most common complications were Nausea and vomiting followed by Post-dural-puncture headache, Urinary retention, Transient neurological symptoms, Mild hypotension etc. and majority patients were satisfied with the

spinal anesthesia

Key Word: Spinal anesthesia, Laparoscopic apendicectomy, Post-dural-puncture headache.

 

 

 

 

INTRODUCTION

Laparoscopic appendicectomy (LA) is the most commonly performed intra- abdominal operation. Semm¹ first introduced the laparoscopic method for appendicectomy in the early 1980s. Since then laparoscopic appendicectomy was made popular by various surgeons and preferred over the open method due to its inherent advantages.² General anesthesia with positive pressure ventilation is the preferred mode of anesthesia in this technique. Regional anesthesia has not been used as the sole anesthetic procedure other than in the scenario of a patient at high risk to undergo laparoscopic appendicectomy with CO2 pneumoperitoneum under general anesthesia. Various study already established the feasibility and safety of spinal anaesthesia for laparoscopic surgery.^3,4 Spinal anesthesia (SA) has the advantage of providing analgesia and total muscle relaxation in a conscious and compliant patient and an uneventful postoperative recovery. At the same time, it also protects against the potential complications of general anesthesia (GA). Despite these advantages, regional anesthesia is still preferred only for patients who are at high risk for general anesthesia, and the majority of surgeons still prefer doing both open and laparoscopic procedures under GA. Thus, most of the publications and textbooks on laparoscopic surgery cite GA as the only anesthetic option for abdominal laparoscopic surgery. But, lately, occasional reports of laparoscopic surgery being performed under regional anesthesia (spinal or epidural) in selected patients have started coming in 5. Of the advantages of spinal anesthesia over general anesthesia is that the patient is awake and oriented at the end of the procedure. Second, the absence of general anesthetic side effects (e.g., nausea and vomiting) and less pain experienced due to the effect of neuraxial analgesia. Third, patients that have received spinal anesthesia tend to ambulate earlier than patients receiving general anesthesia. Finally, complications related to intubation and/or extubation is avoided in spinal anesthesia for patients undergoing laparoscopic interventions. Combining a minimally invasive surgical procedure with a less invasive anesthetic technique appears, theoretically, to further enhance the advantages of the operation⁶.

 

METHODOLOGY

This was a cross sectional study carried out in the department of Anesthesiology of a tertiary health care during the one-year period i.e. January 2017 to January 2018 in the patients undergone spinal anesthesia for the laparoscopic appnediscecomy, during the one year after written consent 66 patients were included into the study. All the patients were undergone spinal anesthesia by all aseptic precaution and standard protocol. All details of the patients like age, sex, complications of spinal anesthesia if any were noted. The patients satisfaction was noted as fully satisfied, Partly Satisfied, Not satisfied. The data is presented in Tabular form and expressed in percentages.

RESULT

Table 1: Distribution of the patients as per the age

The majority of the patients were in the age group of in the age group of 30-40 were 31.82%, 40 -50 were 28.79%, 20-30 were 18.18%, 50-60 were 13.64%, and andgt; 60 were 7.58%.

Table 2: Distribution of the patients as per the sex

The majority of the patients were Male i.e. 57.58% and Female were 42.42%.

 

Table 3: Distribution of the patients as per the various complications

(* More than one complication present in the same patients so total may be more)

The most common complications were Nausea and vomiting in 31.82%, followed by Post-dural-puncture headache in 25.76, Urinary retention in 13.64%, Transient neurological symptoms in 7.58%, Mild hypotension in 4.55%, Bradycardia in 3.03%, lower back pain with pain in the legs in 3.03%.

 

Table 4: Distribution of the patients as per the satisfaction to spinal anesthesia

The majority of the patients were satisfied i.e. 68.18% were Fully satisfied, 18.18 % were Partly Satisfied, 13.64% Not satisfied.

 

DISCUSSION

With recent technical advances, acute appendicitis is more commonly performed under laparoscopy than by open laparotomy. Laparoscopic appendectomy (LA) has shown to have considerable advantages over open appendectomy; such advantages include less postoperative pain, better cosmetic results, a shorter hospital stay, and a lower complication

rate⁸. However, LA has been routinely performed under general anesthesia with endotracheal intubation despite the several disadvantages of general anesthesia compared to regional anesthesia, including hemodynamic instability, postoperative nausea and vomiting (PONV), increase in the requirement for postoperative analgesia, complications related to intubation or extubation, and a sore throat postoperatively^9,10 Laparoscopic appendicectomy is the gold standard for treatment of uncomplicated appendicitis. General anesthesia is regarded as safe anesthesia for laparoscopic surgery in most of the cases till now. Regional anesthesia has not been used as the sole anesthetic procedure other than in the scenario of a patient at high risk to undergo laparoscopic appendicectomy with CO2 pneumoperitoneum under general anesthesia. Single puncture spinal anesthesia can be an easier technique than general anesthesia. 3 Monitoring of patients under spinal anesthesia is easier than general anesthesia. Complication of endotracheal intubations like damage to oral cavity, teeth, sore throat, and aspirations, failure of intubations are absent in spinal anesthesia. Cost of spinal anesthesia is far less than general anesthesia. Nausea and vomiting are less with spinal anesthesia.^3,7 Spinal anesthesia is suitable for all the patients but general anesthesia may be not for e.g. patients with COPD, who are unfit for general anesthesia^11,12.In our study we have seen that The majority of the patients were in the age group of in the age group of 30-40 were 31.82% , 40 -50 were 28.79%, 20-30 were 18.18%, 50-60 were 13.64%, and andgt;60 were 7.58%. The majority of the patients were Male i.e. 57.58% and Female were 42.42%. The most common complications were Nausea and vomiting in 31.82%, followed by Post-dural-puncture headache in 25.76, Urinary retention in 13.64%, Transient neurological symptoms in 7.58%, Mild hypotension in 4.55%, Bradycardia in 3.03%, lower back pain with pain in the legs in 3.03%. The majority of the patients were satisfied i.e. 68.18% were Fully satisfied, 18.18 % were Partly Satisfied, 13.64% Not satisfied. This was similar to Manish K. Singh et al 13 they found Laparoscopic appendicectomy with low-

pressure CO2 pneumoperitoneum can be successfully and safely performed under spinal anesthesia. Furthermore, it seems that spinal anesthesia is associated with minimal postoperative pain and at least an equally good recovery as with general anesthesia.

 

CONCLUSION

It can be concluded from our study that The most common complications were Nausea and vomiting followed by Post-dural-puncture headache, Urinary retention, Transient neurological symptoms , Mild hypotension etc. and majority patients were satisfied with the spinal anesthesia

 

REFERENCES