A Comparative Study of Safety and Efficacy in Laparoscopic Cholecystectomy Under General Anesthesia Versus Thoracic Segmental Spinal Anesthesia

Background and Aims: Laparoscopic cholecystectomy is conventionally performed under general anesthesia; however, segmental thoracic spinal anesthesia has emerged as a potential alternative offering better postoperative recovery. This study aimed to compare intraoperative hemodynamic stability, postoperative recovery profile, and adverse effects between general anesthesia and segmental thoracic spinal anesthesia in patients undergoing elective laparoscopic cholecystectomy. Methods: After obtaining approval from the Institutional Ethics Committee and informed consent from all participants, this randomized prospective study was conducted on 60 patients aged 18–60 years at LLR and associated hospitals, GSVM Medical College, Kanpur. Patients were randomly divided into two groups of 30 each. Group A received general anesthesia with fentanyl (2 µg/kg), propofol (2 mg/kg), and vecuronium (0.1 mg/kg), while Group B received segmental thoracic spinal anesthesia using isobaric levobupivacaine (7.5–10 mg; 1.5–2 ml) with an additive (fentanyl or clonidine). Parameters compared included intraoperative heart rate, mean blood pressure, SpO₂, episodes of bradycardia and hypotension, time to first rescue analgesia, ambulation time, postoperative nausea and vomiting (PONV), shoulder pain, and hospital stay. Results: The time to first rescue analgesia was significantly longer in the segmental spinal anesthesia group compared to general anesthesia. Patients in the spinal group ambulated earlier, while intraoperative hemodynamic parameters were comparable between groups. PONV episodes were more frequent under general anesthesia. Shoulder pain was noted in some spinal anesthesia patients but was effectively managed with intravenous fentanyl. In the study the mean saturation in both groups in different time intervals shows no significant difference with p value >0.05. Conclusion: Segmental thoracic spinal anesthesia provides effective analgesia, faster recovery, and reduced postoperative nausea and vomiting compared to general anesthesia for laparoscopic cholecystectomy, with stable intraoperative hemodynamics and manageable side effects. Key words: Laparoscopic cholecystectomy, general anesthesia, thoracic segmental spinal anesthesia, postoperative recovery, hemodynamic stability.