Laparoscopic Cholecystectomy Under Regional Anaesthesia (Thoracic Spinal): Is It Feasible?

Introduction: Laparoscopic cholecystectomy is classically done under General Anaesthesia as a gold standard. But in this era where regional anaesthesia is gaining more prominence, we wondered about the safety and efficacy of regional anaesthesia for doing Laparoscopic Cholecystectomy. It is considered to have an advantage over General Anaesthesia (GA), especially in cases where a higher risk of morbidity due to GA is present. It also provides excellent pain relief postoperatively, reducing the usage of opioid analgesics and shortening duration of stay. Aims: To evaluate the safety and efficacy of Thoracic Spinal Anaesthesia in Laparoscopic Cholecystectomy through a Surgeon Satisfaction Score (SSS), intra op monitoring and post operative care. Methods and Materials: 45 cases of Chronic Calculous Cholecystitis belonging to ASA Grade I and II, without any comorbidities underwent Laparoscopic cholecystectomy under Thoracic spinal anaesthesia in Tezpur Medical College and Hospital, a tertiary care center. After the surgery, a Surgeon Satisfaction Score was calculated with following parameters - I) Absence of conversion to GA II) Absence of intra operative movements III) Abdominal relaxation during the surgery IV) Absence of Post operative complications after surgery and V) Timely discharge from hospital using 5-point Likert’s scale. Likewise, intra op and post op vitals were monitored and analysed. Results: Thoracic Spinal anaesthesia was found to be adequate for surgery in all but one patient. Intraoperatively, two patients who experienced right shoulder pain received Inj Ketamine 25 mg and Inj Midazolam 1 mg. Two patients were given Mephenteramine 6 mg for hypotension. One patient was given Inj Atropine 0.6 mg for Bradycardia. Surgeon Satisfaction Score was Excellent for most patients. One patient was converted to General Anaesthesia. Postoperatively, three patient required antiemetic for nausea and vomiting. Two patients suffered urinary retention. 42 patients were discharged within 24 hours of surgery. Conclusion: Laparoscopic Cholecystectomy is feasible under Thoracic Spinal Anaesthesia with excellent Surgeon Satisfaction and minimal post operative complications for healthy patients and minimizes post operative hospital stay.