ABSTRACT
Background: The concept that general anesthesia is the only suitable technique for laparoscopic procedures has been changed. Regional anesthesia, including epidural and spinal techniques, combined with the head down position can he used for gynecological laparoscopy without major impairment of ventilation
Aim of the work: This study was designed to compare between lidocaine-fentanyl and bupivacaine-fentanyl spinal anesthesia for operative gynecological laparoscopy regarding the efficacy of the two spinal techniques, patients and surgeons comfort, intra- and postoperative characteristics and complications
Patients and Methods: This is a double blinded randomized prospective study which was conducted at Assuit University Hospital after approval from local ethics committee and informed consent from all patients. The study included 60 women who were scheduled for gynecologic laparoscopy, ASA physical status I and II. Patients were randomly assigned to one of two groups: group I, patients received 2.5 ml 2% plain lidocaine [50 mg] made up to 3 ml solution by addition of 0.5 ml fentanyl [25 microg]. In group II: patients received 2.5 ml 0.5% plain bupivacaine [12.5 mg] made up to 3 ml solution by addition of 0.5 ml fentanyl [25microg]. All patients received 30 mg ketorolac in 500 ml of normal saline, preoperatively, routine monitors were applied [ECG, non invasive blood pressure, pulse oximeter]. The subarachnoid block was performed using a standardized technique. A standardized surgical technique was used for laparoscopy. Shoulder tip pain was recorded and the intensity of pain was measured on a 10-cm visual analog scale [VAS]. Pain >/= 3 on VAS was treated with fentanyl [50microg] and midazolam [1.5 mg] intravenously. Surgical condition, hemodynamic data [non invasive blood pressure [NIBP], heart rate [HR], respiratory rate [RR], O[2] saturation [SpO[2]], arterial blood gas [ABG], intra-operative, and post operative side effects were recorded as nausea, pain and transient neurological symptoms [TNS] in addition to recovery profile including time to full motor and sensory recovery, time to ambulate and time to discharge
Results: There were no significant differences between both groups as regard age, weight, height, body mass index, CO[2] volume and pressure, and pneumoperitonium time. There were no significant differences between the two groups as regard to NIBP, HR, RR, SpO[2], ABG and intra operative complications. Arterial CO[2] tension showed significant increase at 10 min after insufflations in both groups. Surgical condition was rated by surgeons as good to excellent in most patients in both groups with no significant difference between both groups. In the lidocaine group, two patients were excluded from data collection and analysis due to intractable shoulder pain and they required general anesthesia, otherwise shoulder pain >/= 3 on VAS was easily managed in patients in both groups with fentanyl 50microg and midazolam 1.5 mg intravenously. The time to onset of motor block and the time to reach sensory level to T12 and T6 were significantly shorter in the lidocaine group patients in comparison to the bupivacaine group patients. Patients in the lidocaine group showed significantly faster recovery than patients in the bupivacaine group, but unfortunately, they showed significantly higher incidence in TNS than patients in the bupivacaine group. There were no significant differences between both groups regarding postoperative complications
Conclusion: Spinal anesthesia could be a suitable and safe technique for gynecological laparoscopy with a reasonable acceptance from both patients and surgeons. Additionally it possesses the advantage of pain free recovery and low incidence of post operative complications. Even though spinal lidocaine provided faster recovery profile after gynecological laparoscopy than spinal bupivacaine, but it has the disadvantage of higher incidence of TNS