Comparative Study between General Anaesthesia and Thoracic Segmental Spinal Anaesthesia for Laparoscopic Cholecystectomy- A Prospective Randomised Open Label Study At A Tertiary Care Hospital

Abstract Background: Laparoscopic cholecystectomy is preferred for its minimally invasive benefits, like less pain and quicker recovery. However, managing anaesthesia can be complex due to the effects of pneumoperitoneum. While GA is standard, TSSA offers a promising alternative for patients with comorbidities. This study compares GA and TSSA using isobaric ropivacaine with dexmedetomidine to assess patient outcomes. Methods: This study was conducted at Government Medical College, Jammu, India, from August 1, 2023, to July 31, 2024, involving 90 ASA patients aged 18–60 undergoing elective laparoscopic cholecystectomy. They were divided into Group T (n=45, TSSA with 0.75% ropivacaine + 10 µg dexmedetomidine) and Group G (n=45, GA). Data on demographics, hemodynamic, postoperative pain (VAS), satisfaction scores, and discharge times were collected. Statistical analysis included t-tests, Mann-Whitney U tests, and chi-square tests, with P < 0.05 considered significant. Results: Demographic characteristics were similar (age: 34.67 ± 11.9 vs. 38.73 ± 11.29 years, P = 0.103595). Surgical duration was comparable (67.3 ± 8.79 vs. 68.6 ± 10.05 min, P > 0.253). Group T had higher rates of hypotension (20% vs. 2%, P < 0.005) and bradycardia (18% vs. 2%, P < 0.005), as well as greater fluid needs (2317.03 ± 465.06 vs. 1455.18 ± 295.62 mL, P < 0.0001). Postoperative VAS scores were lower in Group T (1.98 ± 1.34 vs. 2.93 ± 1.9 at 4h, P = 0.007794), with higher patient satisfaction (3.91 ± 1.15 vs. 3.49 ± 1.09, P = 0.03321), while surgeon satisfaction favoured GA (3.07 ± 0.61 vs. 3.87 ± 0.83, P = 0.00321). Conclusion: TSSA outperforms GA in laparoscopic cholecystectomy, offering better pain control, higher patient satisfaction, and faster discharge, while maintaining manageable hemodynamic effects. It is safe for patients with respiratory issues like COPD and deserves further research for broader application.