Tzovaras G et al. (2006) Laparoscopic cholecystectomy under spinal anesthesia. Surg Endosc 20: 580–582

General anesthesia is usually used for laparoscopic cholecystectomy—as typically performed, pneumoperitoneum requires endotracheal intubation. Tzovaras et al. conducted a pilot study to see whether laparoscopic cholecystectomy can be successfully performed under regional anesthesia alone—regional anesthesia is associated with reduced postoperative risks, pain, and recovery time. The authors obviated the need for endotracheal intubation by using a nasogastric tube to decompress the stomach, thereby avoiding vomiting and aspiration of stomach contents. They limited any discomfort due to peritoneal irritation by using low-pressure CO2 pneumoperitoneum and minimal, if any, tilting of the operating table.

Between May and July 2004, 15 patients (12 female), with a median age of 41 years (range 27–64 years), underwent laparoscopic cholecystectomy under spinal anesthesia. No major adverse events occurred during the procedures; however, two patients experienced severe shoulder pain requiring intravenous administration of fentanyl, and one patient experienced nausea, requiring administration of granisetron. Their operations were then completed uneventfully. Four patients experienced postprocedure nausea and/or vomiting, which was successfully treated with granisetron. At 2-week follow-up, 14 of the patients reported that they would recommend spinal anesthesia for laparoscopic cholecystectomy; the dissenting patient had experienced severe shoulder pain during and after the procedure, and had also developed urinary retention. No late complications were observed.

The authors conclude that regional anesthesia for laparoscopic cholecystectomy is safe and feasible. A prospective, randomized, controlled trial directly comparing general and spinal anesthesia for this procedure is currently underway.