Comparison Of Feasibility And Safety Of Laparoscopic Appendicectomy Under Spinal Anaesthesia Vs General Anaesthesia, One Year Randomised Controlled Trial At A Tertiary Care Hospital

Abstract

Background: Laparoscopy has revolutionised surgery and management of the patient with marked decrease in morbidity and post-operative complications. Initially, these procedures were done using only General Anaesthesia. However, now with the introduction of Spinal anaesthesia and after learning its advantages, surgeons are slowly beginning to gravitate towards this mode of anaesthesia. There are different schools of thought which advocate the use of one method over the other and surgeons are still cautious about performing laparoscopic surgery under Spinal anaesthesia. Hence, this study has been taken up to compare the various parameters that may vary when using different methods of anaesthesia and to assess whether one particular method is superior or a safer option when compared with the other. Aims and Objectives: The aim of this study is to assess intra operative pain and hemodynamic stability during laparoscopic appendectomy under Spinal anaesthesia in comparison to General anaesthesia and to compare post-operative pain and incidence of post-operative nausea and vomiting between the two methods. Methods: Sixty three patients who were admitted in the hospital for appendicitis participated in this Randomized controlled trial conducted in a tertiary care hospital in India. Thirty patients were randomly included in Group A (undergoing laparoscopic surgery under Spinal Anaesthesia) and thirty three patients in Group B (undergoing laparoscopic surgery under General Anaesthesia). Necessary baseline haematological investigations and imaging was done following which patients were taken up for laparoscopic surgery. The patients’ BP, heart rate, SPO2 and ECG were recorded prior to induction, during surgery and at 15 minute intervals following surgery. The intra operative conditions, ease of operating under Spinal anaesthesia and muscle relaxations were assessed and graded by the surgeon. All the patients were monitored for nausea and vomiting, headache, sorethroat and transient neurological symptoms. Pain was assessed using visual analogue scale (VAS) and graded at 1, 3, 6, 12hours. Intensity of pain was assessed by using 10 point VAS. Statistical analysis was done using the Chi-square test and the Unpaired student t test. Results: 10% of the patients who underwent Spinal anaesthesia developed bradycardia while 6.66% developed hypotension. The difference between the heart rates of the two groups was found to be significant from 3 minutes prior to surgery to 45 minutes after surgery. The mean values of Systolic and diastolic pressure was found to be significantly higher in patients who were administered General anaesthesia and no change in the respiratory functions was observed following administration of either Spinal or General anaesthesia. 26.67% of the patients who underwent surgery under Spinal anaesthesia complained of pain in the shoulder on the right side and this difference was statistically significant. Patients who underwent laparoscopic surgery under general anaesthesia recorded higher levels of pain as compared to those under spinal anaesthesia for twelve hours following surgery. However, the difference between the VAS scores for pain between the two groups was significant only up to three hours following surgery. After six hours, this difference was not found to be significant. Only 6.67% of patients who underwent surgery under Spinal anaesthesia complained of PONV compared to 21.21% of the patients who underwent surgery under General anaesthesia. 3.33% of the patients developed post-operative headache after having underwent surgery under Spinal anaesthesia while 12.12% of patients who underwent surgery under general anaesthesia developed sore throat. Conclusion: Laparoscopic surgery under Spinal anaesthesia is a viable and safe alternative as compared to General anaesthesia. The recovery rates and the satisfaction reported by patients is also better. Spinal anaesthesia also helps in maintaining better haemodynamic stabilization. It has the advantages of lesser incidence of post-operative complications related to pain. In patients for whom General anaesthesia is a poor choice, Spinal anaesthesia can be considered as a safe alternative. However more studies are required to further establish the feasibility of performing laparoscopic appendectomy under spinal anaesthesia.