Comparison of combined spinal and general anesthesia block and combined epidural and general anesthesia block in laparoscopic cholecystectomy

Objective. Combined spinal and general anesthesia block (CSGAB) and combined epidural and general anesthesia block (CEGAB) in laparoscopic cholecystectomy were compared. Material and methods. Forty patients were randomly selected (ASA physical status I-II) to receive sevoflurane plus 10 to 15 mg of bupivacaine weighed at 0.5% and 20 jig of fentanyl (CSGAB) or sevoflurane plus 150 mg of ropivacaine and 1 mu g/kg of fentanyl (CEGAB). Blood pressure, heart rate, oxygen and carbon dioxide saturation, drug doses and sevoflurane MAC (minimum alveolar concentration) were evaluated during surgery. Anesthesia recovery time and pain intensity and duration were evaluated during the first two postoperative hours. Frequency of incisional or referred pain, dyspnea, headache, cramping, nausea and vomiting were evaluated 24 hours after surgery. Statistical analysis was carried out using the Chi-square test and Student t test. Relative risk, absolute risk reduction and number needed to treat (NNT) for adverse reactions were determined. Results. Systolic and diastolic arterial pressures posterior to semi-Fowler's position were lower in the CSGAB group than in the CEGAB group. (94 +/- 16 vs. 110 +/- 18 mmHg; p < 0.01 and 59 +/- 8 vs. 69 +/- 12, mmHg; p < 0.01, respectively). Anesthesia recovery time (32 +/- 17 vs. 61 +/- 29 minutes; p < 0.01) and pain duration (26 +/- 42 vs. 83 +/- 46 minutes; p < 0.01) were shorter in the CSGAB group. NNT was 8 for postoperative pain, 8 for nausea, and 95 for vomiting. Conclusions. CSGAB was more efficacious for rapid anesthesia recovery and had a shorter post-operative pain duration than CEGAB.