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Objectives: Effective post-operative pain control is an essential component of care of surgical patients. Various analgesic regimens have been used to ensure adequate postoperative pin relief. We conducted this study to compare the efficacy of spinal anesthesia versus general anesthesia regarding post-operative pain following laparoscopic cholecystectomy
Methodology: After approval of the hospital ethical committee, 120 females were included in our randomized, control trial from 1 July 2015 to 31 Dec 2015. Patients were explained about the study and informed consent was signed by them or their guardians. Patients were randomly divided into two groups; in Group-A patients, spinal anesthesia was achieved with 3 ml 0.5% hyperbaric bupivacaine hydrochloride and 25 microg fentanyl. Group-B was given GA. All the patients were premedicated with IV metoclopramide 10 mg and dexamethasone 8 mg; preemptive analgesia with 0.1 mg/kg nalbuphine was done. Induction of GA was done with propofol 2 mg/kg, muscle relaxation was achieved with atracurium besylate 0.5 mg/kg. Endotracheal intubation with 6.5 or 7 mm cuffed tube was done, Visual analogue scale [VAS] was used to assess pain severity at immediate post-operative period (S-0) and at 6 hours [S-6]. Data was analyzed using SPSS version 16.0. For quantitative variables like pain score and age, mean and standard deviation [SD] were calculated. For qualitative variables like severity of pain, frequency and percentages were calculated. Chi-square test was used to measure frequency of pain between two groups. P-value < 0.05 was taken as significant
Results: The two groups did not differ in demographic profiles. At S-0, the mean score in Group-A was 2.89 +/- 2.49 [mode = 1, median 2] versus 3.83 +/- 2.56 [mode = 3, median = 3], p value 0.0364. At zero hours [S-0]; 6 [10%] patients in Group-A had no pain [VAS less than 2], 28[46.6%] patients had mild pain and 26 [43.3%] patients had severe pain. In Group-B 8[13.3%] had no pain, 20[333%] had mild pain and 32[55%] patients had severe pain. The p value was 0.947, which is statistically insignificant At S-6, the mean VAS was 6.94 [median = 7, mode = 8] in Group-A versus 6.23 +/- 2.11 [median = 6, mode = 5] in Group-B, p value 0.0277. At six hours [S-6], 31[51.6%] patients no mild pain in Group-A, 24[40%] had mild pain and 5[8.3%] had severe pain. Whereas 30 [50%] patients had no pain, 8 [13.3%] patients had mild pain and 22 [36.6%] patients had severe pain in Group-B. The p-value was 0.022, which is statistically significant
Conclusion: Our study has shown that single shot spinal anesthesia provides better postoperative analgesia in the postsurgical period. The addition of intrathecal fentanyl provides adequate analgesia, including relief from shoulder tip pain. So, spinal anesthesia can be safely used as sole anesthesia for laparoscopic cholecystectomy
RESUMO
Intraoperative cardiac arrest in usual position [prone or lateral] present a unique challenge to the anesthesiologist, where changing to supine position can result in undue delay in initiating CPR or it is not feasible due to skull being fixed and opened by the surgeon. A 25 kg girl, 6 years old, was undergoing posterior cranial fossa surgery for fourth ventricle tumor excision. She went into hemorrhagic hypovolemic cardiac arrest, despite fluid resuscitation. Immediately, CPR was started in prone position with one hand at the midthoracic spine between the scapulae. The patient had ROSC after 20 min of CPR. Our patient did not have a favorable outcome, but the resuscitation in the prone position generated sufficient cardiac output while the correction of hypovolemia and hemostasis could be achieved. We recommend that immediate initiation of CPR even in prone position is the best choice in intraoperative patients, where change in position would result in delay in chest compression or make the surgical access impossible