Laparoscopic cholecystectomy (LC) is one of the most widely practiced surgical procedures in abdominal surgery. Patients undergo LC during general anaesthesia; however, in recent years, several studies have suggested the ability to perform LC in patients who are awake. We report a case of awake LC and a literature review.

A 69-year-old patient with severe pulmonary disease affected by cholelithiasis was scheduled for LC under regional anaesthesia. We first performed peridural anaesthesia at the T8-T9 level and then spinal anaesthesia at the T12-L1 level. The procedure was managed in total comfort for both the patient and the surgeon. The intra-abdominal pressure was 8 mmHg. The patient remained stable throughout the procedure, and the postoperative course was uneventful.

Evidence has warranted the safe use of spinal and epidural anaesthesia, with minimal side effects easily managed with medications. Regional anaesthesia in selected patients may provide some advantages over general anaesthesia, such as no airway manipulation, maintenance of spontaneous breathing, effective postoperative analgesia, less nausea and vomiting, and early recovery. However, this technique for LC is not widely used in Europe; this is the first case reported in Italy in the literature. Regional anaesthesia is feasible and safe in performing some types of laparoscopic procedures. Further studies should be carried out to introduce this type of anaesthesia in routine clinical practice.

• Laparoscopic cholecystectomy
• Awake surgery
• Awake laparoscopy
• Gallstone disease
• Regional anaesthesia
• Spinal anesthesia
• Case report

• central neuraxial block
• neuraxial anaesthesia
• regional anaesthesia
• spinal anaesthesia
• thoracic anaesthesia

• Humans
• Anesthesia, Spinal/adverse effects
• Anesthetics, Local
• Anesthesia, Local
• Anesthesia, General

To compare spinal anesthesia (SA) with general anesthesia (GA) in gynecologic laparoscopic surgery regarding anesthetic parameters and patient satisfaction together with an assessment of total oxidant, antioxidant levels, and Oxidative Stress index (OSI).

Sixty patients who were planned to undergo gynecologic laparoscopy were randomized into group G (GA) and group S (SA). Demographics, adverse events and anesthetic parameters were recorded before induction, after induction, and at the 5^th, 10^th, 15^th, 30^th, 60^th, 90^th, and 120^th minutes. Patients and surgeons completed questionnaires. Total antioxidant capacity (TAC), total oxidant level (TOL), and OSI were measured.

There was no difference between the groups in terms of hemodynamic parameters except heart rate at 30^th minute and mean arteral pressure at 10^th, 15^th, 30^th, and 60^th minute (p<0.05). The postoperative arterial blood pH value was lower in group S (p=0.021). Intraoperative hypotension was lower in group S (p=0.038). There was more intraoperative hypotension in group S when compared with group G (p=0.038). Postoperative analgesic consumption was higher and onset of postoperative pain was shorter in group G (p=0.001 for both). There was no difference between the groups in terms of patient and surgeon satisfaction. There was no difference in terms of TAC, TOL, and OSI between the groups (p=0.862, p=0.940, and p=0.728, respectively).

SA may become a reliable alternative to GA in gynecologic laparoscopy when hemodynamic and respiratory parameters, patient and surgeon satisfaction, as well as total oxidant, antioxidant levels, and OSI are considered.

• Gynecologic laparoscopy
• general anesthesia
• oxidative stress
• patient satisfaction
• spinal anesthesia

• Laparoscopic cholecystectomy
• general anesthesia
• postoperative pain
• spinal anesthesia
• surgeon satisfaction

• ambulatory surgery
• day case surgery
• intraincisional infiltration
• intraperitoneal instillation
• local anaesthetic
• post-operative pain
• ropivacaine

Epidemiological data demonstrate that the worldwide prevalence of chronic obstructive pulmonary disease is increasing. These patients have an increased risk of mortality and morbidity and have constant limitations in airflow. Comparing laparoscopic cholecystectomy (LC) in patients with chronic obstructive pulmonary disease (COPD) under spinal anesthesia (SA) and general anesthesia (GA).

We prospectively evaluated COPD patients who underwent laparoscopic cholecystectomy under general anesthesia (Group 1, n = 30) or spinal anesthesia (Group 2, n = 30) in our clinic between January 2016 and January 2018. Patients with COPD were further divided into groups according to their preoperative stages (Stage 1–4). Intraoperative vital findings, postoperative pain, complications, and length of hospitalization were compared between the general (GA) and spinal anesthesia (SA) groups.

The mean age of the patients in the GA group was 61.0 ± 6.7 years and was 61.0 ± 7.7 years in the SA group. In the GA and SA groups, the mean ASA score was 2.8 ± 0.6 and 2.9 ± 0.6, respectively, the mean operation duration was 31.7 ± 5.1 and 30.6 ± 5.1 min, respectively, and the length of hospitalization was 3.2 ± 1.7 and 1.5 ± 0.5 days, respectively. The partial carbon dioxide rates (PaCO2) at the postoperative 5th and 20th minutes were lower in the SA group than in the GA group. Further, the requirement for postoperative analgesia was lower in the SA group, and the length of hospitalization was significantly shorter in the SA group. There was no significant difference between the two groups in terms of operation duration.

Laparoscopic cholecystectomy is a rather safe procedure for COPD patients under general and spinal anesthesia. However, spinal anesthesia is preferred over general anesthesia as it has better postoperative analgesia and causes no impairment of pulmonary functions.

The online version of this article (10.1186/s12893-018-0396-1) contains supplementary material, which is available to authorized users.

• COPD
• Cholecystectomy
• Laparoscopic
• Regional anesthesia
• Spinal anesthesia

• Anesthesia
• Cholecystectomy, laparoscopic
• Pain, referred
• Patient safety
• Review, systematic

To evaluate the effects of intravenously infused lidocaine on analgesia and gastrointestinal function of patients receiving laparoscopic common bile duct exploration.

Seventy-eight patients with cholelithiasis were randomly divided into a treatment group and a control group (n=39) that all had laparoscopic common bile duct exploration. The treatment group was intravenously infused with 1.5 mg/kg lidocaine by using a venous pump under anesthesia induction at the speed of 2 mg·kg^-1 ·h^-1 until the end of surgery, while the control group was given normal saline with the same volume.

All patients successfully completed the surgery, with similar surgical time, incision length and intraoperative blood loss. The required lidocaine concentrations of the treatment group were 2.64±1.23 μg/ml, 1.14±0.4 μg/ml and 0.93±0.32 μg/ml respectively 2 hour, 12 hour and 48 hour after surgery. Pain score of the treatment group, which was significantly lower than that of the control group at the postoperative 2 hour (P<0.05), was similar to those of the control group at the postoperative 12 hour and 48 hour. With extended time, the pain score significantly decreased (P<0.05). The treatment group had significantly shorter first anal exhaust time and first defecation time than those of the control group (P<0.05). Adverse reactions, such as nausea and vomiting, dizziness, headache, subcutaneous emphysema and fat liquefaction of incision, occurred similarly in the two groups, which were alleviated by symptomatic treatment.

Laparoscopic common bile duct exploration is a promising minimally invasive surgery for patients with cholelithiasis, during which intravenously infused lidocaine can rapidly recover the gastrointestinal function and exert short-term analgesic effects, with mild adverse reactions also.

• Adverse reaction
• Analgesia
• Gastrointestinal function
• Laparoscopic common bile duct exploration
• Lidocaine

• cholecystectomy
• laparoscopic
• laparoscopy
• regional anesthesia
• spinal anesthesia

• Anesthesia, General/methods
• Anesthesia, Spinal/methods
• Cholecystectomy, Laparoscopic/methods
• Humans
• Operative Time
• Pain, Postoperative/epidemiology
• Postoperative Complications/epidemiology
• Postoperative Nausea and Vomiting/epidemiology
• Randomized Controlled Trials as Topic

Rapid and uneventful postoperative recovery following general anesthesia in morbidly obese patients undergoing bariatric surgery may offer challenges to anesthesiologists. With improved surgical techniques and shorter pneumoperitoneum, regional anesthesia may be considered for this laparoscopic procedure in selected cases.

The first patient was a 60-year-old male (body mass index: 39 kg/m²) who was scheduled for laparoscopic sleeve gastrectomy. The second patient was a 46-year-old female (body mass index: 47 kg/m²) who was scheduled for laparoscopic gastric bypass. After standard intraoperative monitoring was applied, epidural anesthesia was performed at thoracic level T9–T10. Surgical technique modification included insufflation of CO₂ at a low flow rate and avoidance of orogastric tube use. During the procedure, both patients breathed spontaneously without difficulty. One hypotension episode occurred and was successfully treated with a 12-mg bolus of ephedrine in case 1. Shoulder pain occurred intraoperatively in case 2 and was successfully treated with a 50-μg bolus of fentanyl. Postoperatively, 2 mg epidural morphine was administered for postoperative analgesia. Both patients were satisfied with the anesthesia technique and was discharged uneventfully.

This anesthetic technique may maintain pre-operative respiratory function, increase alertness, and reduce the use of rescue analgesics, which is crucial for optimal outcomes in morbidly obese patients. Conversion of epidural anesthesia to general anesthesia may be required if patients can not tolerate the laparoscopic procedure (e.g. intolerable shoulder pain) or the increased respiratory rate during pneumoperitoneum leading to difficulty in performing laparoscopic surgery. Further studies are needed to elucidate this issue.

General anesthesia is widely used for laparoscopic bariatric surgery, but epidural anesthesia may be a viable alternative to general anesthesia in selected cases. Further prospective studies may be required to elucidate the relative advantages and disadvantages of epidural anesthesia in this surgical population.

• Epidural anesthesia
• Laparoscopic bariatric surgery
• Obesity

Laparoscopic cholecystectomy became the standard surgery for gallstone disease because of causing less postoperative pain, respiratory compromise and early ambulation.

This study was designed to compare spinal anesthesia, (segmental thoracic or conventional lumbar) vs the gold standard general anesthesia as three anesthetic techniques for healthy patients scheduled for elective laparoscopic cholecystectomy, evaluating intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction.

A total of 90 patients undergoing elective laparoscopic cholecystectomy, between January 2010 and May 2011, were randomized into three equal groups to undergo laparoscopic cholecystectomy with low-pressure CO₂ pneumoperitoneum under segmental thoracic (TSA group) or conventional lumbar (LSA group) spinal anesthesia or general anesthesia (GA group). To achieve a T₃ sensory level we used (hyperbaric bupivacaine 15 mg, and fentanyl 25 mg at L2/L3) for LSAgroup, and (hyperbaric bupivacaine 7.5 mg, and fentanyl 25 mg at T10/T11) for TSAgroup. Propofol, fentanyl, atracurium, sevoflurane, and tracheal intubation were used for GA group. Intraoperative parameters, postoperative recovery and analgesia, complications as well as patient and surgeon satisfaction were compared between the three groups.

All procedures were completed laparoscopically by the allocated method of anesthesia with no anesthetic conversions. The time for the blockade to reach T₃ level, intraoperative hypotensive and bradycardic events and vasopressor use were significantly lower in (TSA group) than in (LSA group). Postoperative pain scores as assessed throughout any time, postoperative right shoulder pain and hospital stay was lower for both (TSA group) and (LSA group) compared with (GA group). The higher degree of patients satisfaction scores were recorded in patients under segmental TSA.

The present study not only confirmed that both segmental TSA and conventional lumber spinal anesthesia (LSA) are safe and good alternatives to general anesthesia (GA) in healthy patients undergoing laparoscopic cholecystectomy but also showed better postoperative pain control of both spinal techniques when compared with general anesthesia. Segmental TSA provides better hemodynamic stability, lesser vasopressor use and early ambulation and discharge with higher degree of patient satisfaction making it excellent for day case surgery compared with conventional lumbar spinal anesthesia.

• General anesthesia
• laparoscopic cholecystectomy
• segmental thoracic spinal anesthesia

Traditionally laparoscopic cholecystectomy is done under general anesthesia. But recently there is a growing interest to get it conducted under central neuraxial blockade. We conducted a clinical study comprising bupivacaine alone or a combination of bupivacaine and clonidine (2 μg/kg) in thoracic epidural anesthesia for laparoscopic cholecystectomy (LC). The aim was to attenuate the undesirable hemodynamic changes due to pneumoperitoneum (PNO) and achieve a better qualitative blockade.

After taking approval from Institutional Ethical Committee, 50 adult patients of ASA grade I and II were divided into two groups; group A where bupivacaine was given with 2 μg/kg of clonidine (Cloneon, Neon) and in group B bupivacaine (Anawin, Neon) was given with 1 ml of saline as placebo. Thoracic epidural was given at the T₉-T₁₀ or T₁₀-T₁₁ interspace to obtain a block of T₄-L₂ dermatome. Hemodynamic parameters like heart rate (HR), noninvasive blood pressure (NIBP), respiratory rate (RR), electrocardiogram (ECG), oxygen saturation (SpO₂) and arterial pressure of carbon dioxide (PaCO₂) were monitored and readings were recorded before and 10 minutes (min.) after the blockade and then at 5 min, 15 min and 30 min after PNO and 15 min after exsufflation.

All the parameters of the patients in group A remained stable but the patients of group B showed an increase in mean arterial pressure (MAP) and HR at 5, 15 and 30 min after PNO and 15 min after exsufflation as compared to Group A. PaCO₂, SpO₂ and RR values in both the groups were comparable. In group A, two patients complained of shoulder pain while in group B12 patients complained of shoulder pain.

Thoracic epidural anesthesia for LC is a satisfactory alternative technique in selected cases. Addition of clonidine (2 μg/kg) to bupivacaine produces better qualitative anesthetic conditions. It prevents hemodynamic perturbations produced by pneumoperitoneum and also decreases the incidence of shoulder pain. Thus we strongly advocate the incorporation of clonidine as an adjuvant in thoracic epidural anesthesia for LC.

• cholecystectomy
• clonidine
• epidural anesthesia
• α2-adrenergic receptor agonists

• Global Surgery
• LMIC
• Laparoscopy
• Low-resource settings
• Training/courses

• Cortisol
• laparoscopic cholecystectomy
• spinal anesthesia

• Combined spinal and epidural anesthesia
• General anesthesia
• Laparoscopic assisted vaginal hysterectomy
• Laparoscopic cholecystectomy
• Regional anesthesia
• Total laparoscopic hysterectomy

Laparoscopic cholecystectomy (LC) is normally performed under general anesthesia. But of late this operation has been tried under regional anesthesia successfully without any added complications like epidural anesthesia.

The aim of the study was to study the feasibility of performing LC under epidural anesthesia in normal patients so that the benefits could be extended to those high-risk patients having symptomatic gallstone disease and compromised cardio-pulmonary status where general anesthesia is contraindicated.

In all, 20 patients with the American Society of Anesthesiologist's class I or II were enrolled in the study. The level of epidural block and satisfaction score, both for the patient and the surgeon, were noted in the study.

The LC was performed successfully under epidural anesthesia in all but two patients who had severe shoulder pain in spite of giving adequate analgesia and were converted to general anesthesia.

The LC can be performed safely under epidural anesthesia with understanding between patient and surgeon. However, careful assessment of complications in the patients should be done to make the procedure safer.

• Cholecystectomy
• Epidural anesthesia
• Laparoscopic
• Shoulder pain

• Cholecystectomy
• laparoscopic
• spinal anesthesia

• Cholecystectomy
• Gallstone disease
• Laparoscopic cholecys-tectomy
• Laparoscopy
• Regional anesthesia
• Spinal anesthesia

• Adult
• Anesthesia, General/adverse effects
• Anesthesia, General/economics
• Anesthesia, Spinal/adverse effects
• Anesthesia, Spinal/economics
• Blood Pressure/physiology
• Carbon Dioxide/blood
• Cholecystectomy, Laparoscopic/economics
• Cholecystectomy, Laparoscopic/methods
• Female
• Humans
• Male
• Middle Aged
• Oxygen/blood
• Pain Measurement
• Pain, Postoperative/epidemiology
• Patient Satisfaction
• Perioperative Care
• Pneumoperitoneum, Artificial
• Positive-Pressure Respiration
• Respiration, Artificial
• Shoulder Pain/epidemiology
• Young Adult

• cholecystectomy
• gallstone disease
• laparoscopic cholecystectomy
• laparoscopy
• low-pressure pneumoperitoneum
• regional anesthesia
• spinal anesthesia

• Epidural anesthesia
• Laparoscopic cholecystectomy
• Referred pain