Spinal versus general anesthesia for laparoscopic cholecystectomy: a comparative study of cost effectiveness and side effects

ABSTRACT

Laparoscopic cholecystectomy [LC] has become a well developed surgical procedure. Currently LC is performed under general anaesthesia. As with any day case procedure, LC requires an anesthetic technique which provides rapid recover and fewer side effects. Meanwhile beside patient's satisfaction, cost effectiveness is an important measure of quality of care. We designed a controlled, randomized trial in order to compare spinal anesthesia with general anesthesia for elective LC in reference to recovery times, hospital stay and costs of anesthesia at our setting. Fifty ASAI-II patients undergoing elective LC, were divided into two groups [25 patients each]; spinal anesthesia group [SA] and general anesthesia group [GA]. Standardized techniques of anesthesia were employed in both groups. VAS score was used for pain assessment postoperatively. The dose of analgesic required as well as the length of hospital stay was also recorded. The cost of each anesthetic technique was calculated. Statistical analysis was performed using SPSS version 13. VAS scores at admission to PACU were less with SA than with GA, and the need for analgesics for postoperative pain was also significantly less [P<0.05]. Patients in general anesthesia group showed a reduction in length of stay in PACU compared to spinal anesthesia group [29.4 +/- 7.2 min versus 42.7 +/- 4 min respectively [P<0.05]]. No significant difference regarding hospital stay in both groups was noted; median hospital stay was 1 day [with a range of 1 to 3 days, and no patient required readmission for any reason. The total costs in SA group was significantly less than GA group; 14.54 +/- 4.2$ versus 17.17 +/- 3.2$ respectively [P<0.05]. We conclude that SA is associated with less anesthetic cost compared to general anesthesia, lower postoperative pain and comparable hospital stay. Further studies are needed on the use of spinal anesthesia for high risk patients