RÉSUMÉ
Background: The choice between spinal-epidural anesthesia and general anesthesia for laparoscopic cholecystectomy depends on various factors, including patient characteristics, surgical team expertise, and institutional guidelines. While both techniques have their advantages and disadvantages, spinal-epidural anesthesia offers an alternative to general anesthesia, potentially reducing complications and improving patient outcomes. Objective of the study was to compare spinal anesthesia with the gold standard general anesthesia for elective laparoscopic cholecystectomy in healthy patients. Methods: This study was conducted at Sheikh Hasina Medical College, Hobiganj, Bangladesh. In this prospective comparative study, we enrolled one hundred patients diagnosed with symptomatic gallstone disease and classified as American Society of Anesthesiologists (ASA) status I or II. These patients were subjected to randomization, with fifty of them assigned to undergo laparoscopic cholecystectomy under spinal anesthesia, while the remaining fifty received general anesthesia. Subsequently, we conducted a comprehensive assessment, comparing various intraoperative parameters, postoperative pain levels, incidence of complications, recovery rates, and patient satisfaction during the follow-up period, with the aim of evaluating the differences between these two anesthesia methods. Results: All the procedures were completed by the allocated method of anesthesia, as there were no conversions from spinal to general anesthesia. Pain was significantly less at 4 hours (p<0.001), 8 hours (p<0.001), 12 hours (p<0.001), and 24 hours (p=0.02) after the procedure for the spinal anesthesia group compared with those who received general anesthesia. There was no difference between the 2 groups regarding complications, hospital stay, recovery, or degree of satisfaction at follow-up. Conclusions: Spinal anesthesia is adequate and safe for laparoscopic cholecystectomy in otherwise healthy patients and offers better postoperative pain control than general anesthesia without limiting recovery.
RÉSUMÉ
Enhancing the production potential and socio- economic level of farmers, altogether 325 front line demonstrations on field pea were laid out comprising 325 farmers covering the total area 160 ha with demonstration plots ranging from 0.20 to 1.0 ha during the year 2015- 16 to 2022- 23 in 14 different villages of Khowai district of Tripura to disseminate the production technology of improved varieties viz., Malviya Matar- 15 (HUDP- 15), Prakash (IPFD 1-10), Aman (IPF 5-19). Field diagnostic visits, regular inspection, farmer’s trainings, group discussion, field days ensured application of balanced and optimum doses of nutrient, and timely plant protection measures. The productivity ranged from 11.50 to 13.50 q/ ha with average yield under demonstration recorded 12.21 q/ ha under improved technology on farmers field as against a yield ranged from 6.75 to 8.50 q/ ha with a mean of 7.52 q/ ha recorded under farmers practice. However, in the demonstration plot the yield enhancement due to technological intervention was 62.15% over the farmer’s practice. An average net returns of Rs 24,441/- at demonstrations plot, while the average net returns from farmers practice is Rs 7218. The additional cost of Rs 5440 gave additional net return of Rs. 17,223/ ha. The increased cost benefit ratio was also estimated; it ranged from 1.56 to 1.97 in recommended practices and 1.11 to 1.36 in farmers practice. An extension gap of 4.69 q/ ha was found between demonstrated technology and farmers practice, technology gap being observed 12.41 q/ ha, whereas technology index 49.87%. Therefore, cluster front line demonstration of field pea was effective for increasing the productivity of field pea and changing the knowledge, attitude and skill of the farmers. This created greater awareness and motivated the other farmers to adopt improved practices of field pea.