Thoracic Epidural Anaesthesia for Open Cholecystectomy

Objective: To compare the postoperative pain relief and vomiting and the length of hospital stay in patients undergoing open cholecystectomy under general anaesthesia versus those receiving thoracic epidural anaesthesia. Study Design: Quasi experimental study. Place and Duration of Study: The Combined Military Hospital, Skardu, from February 2009 to July 2010. Methodology: American Society of Anaesthesiology (ASA) physical status (PS) I and II patients of either gender undergoing un-complicated open cholecystectomy were randomly divided into two groups, group 1 (n=51) received general anaesthesia (GA) and group 2 (n=49) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for postoperative pain, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and obtain the p-value. P-value of less than 0.05 was considered significant. Results: Thirty six patients of GA group did not require additional analgesics for postoperative pain relief; however, injection Ketorolac had to be administered to 15 patients (29.4%) for pain relief in the postoperative period. Two patients (4.1%) in the EA group required additional analgesic during that period. Eleven patients (21.5%) in the GA group had postoperative vomiting. In the EA group only 1 patient (2%) had postoperative vomiting. Patients in EA group had better postoperative pain relief (p = 0.001) and remained free from vomiting than the GA group (p = 0.003). Thirty six patients (70.5%) of the GA group and 34 patients (69.4%) in the EA group were discharged within 36 hours postoperatively (p = 0.896). Conclusion: The use of intra-operative epidural anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the postoperative pain and vomiting in patients undergoing open cholecystectomy.