Muhammad Nazim Khan, Muhammad Naeem Ashraf, Hina Dilruba Khan.
Spinal Anesthesia versus General Anesthesia for Open Cholecystectomy: Comparison of Postoperative Course.
Ann Pak Inst Med Sci Jan ;9(2):95-8.

Objective: To study the effectiveness of SA (Spinal anesthesia) for open cholecystectomy as compared to GA (General anesthesia) in terms of reducing post operative pain, analgesia requirement, respiratory complications and length of hospital stay. Study Design: Quasi Experimental Study Place and Duration: POF Hospital, Wah Cantt from January 2009 to December 2010 Materials and Methods: All consented patients of ASA grade I and II of either sex scheduled for elective open cholecystectomy were randomly divided into two groups. SA Group received Spinal anesthesia (SA) with hyperbaric bupivacaine intrathecally and GA Group received General anesthesia (GA) with propofol, fentanyl, atracurium and sevoflurane during open cholecystectomy. The main end points of the study were post operative pain free interval, analgesia requirements, respiratory complications and length of hospital stay in both the groups. Results: 102 patients were admitted with symptomatic cholelithiasis from January 2009 to December 2010. 2 patients preferred GA and 1 patient opted for SA by their choice so they were excluded from the study. Thus from a total of 99 patients, 49 patients under went open cholecystectomy under SA (SA Group) and 50 patients under GA (GA Group). The average time of first complaint of post operative pain in SA Group was 4 hours as compared to 30 minutes(P=<0.0001) in GA Group. 79% of the SA Group patients remained satisfied with inj. Diclofenac as compared to 17% in GA Group(P=<0.0001). 78% of patients in GA Group also required rescue analgesia in the form of IV ketorolac and 5% of patients received additional IV tramadol for pain relief. Only 5% of the patients in SA Group suffered significant respiratory problems as compared to 11% of patients in GA Group. Mean hospital stay in SA Group was 2.5 day as compared to 4 days in GA Group(P=<0.0001). Conclusion: For patients undergoing uncomplicated open cholecystectomy, spinal anesthesia is not only safe but also more effective than general anesthesia in reducing post operative pain, analgesic requirement, respiratory problems and length of hospital stay.

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