Thoracic Segmental Spinal Anaesthesia for Laparoscopic Cholecystectomy: A Quasi- Experimental Study

Md. Nazmul Huda  Naim; Fatema  khatun; Md.  Fahad; Ahsan Habib  Khan; Nahin  Mahmud; Md Mostafa Kamal; Mohammad Shafiqul  Islam; Debabrata  Banik

doi:10.62848/bjpain.v5i2.1987

Authors

Md. Nazmul Huda Naim Resident, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka.
Fatema khatun Assistant Registrar, Department of Gynaecology & Obstetrics, Shaheed M. Monsur Ali Medical College and Hospital, Sirajganj
Md. Fahad Specialist, Department of Anaesthesia, BRB Hospitals Limited, Dhaka
Ahsan Habib Khan Medical officer (OSD), Directorate general of health services (DGHS), Dhaka.
Nahin Mahmud Medical Officer, Department of Anaesthesia and ICU, Enam medical College and Hospital, Savar,Dhaka
Md Mostafa Kamal Assistant Professor, (OSD) DGHS, MOHFW & Clinical Fellow, Bangladesh Medical University, Dhaka https://orcid.org/0000-0002-4665-1904
Mohammad Shafiqul Islam Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka https://orcid.org/0000-0003-3443-7828
Debabrata Banik Professor, Department of Anaesthesia, Analgesia and Intensive Care Medicine, Bangladesh Medical University, Dhaka

DOI:

https://doi.org/10.62848/bjpain.v5i2.1987

Keywords:

Laparoscopy, Cholecystectomy, Spinal anaesthesia, Thoracic, Segmental

Abstract

Background: Laparoscopic surgery is normally performed under general anaesthesia but regional techniques have been emerging and found beneficial. This regional anaesthesia technique could be a potential alternative to GA. This technique also supports green anaesthesia by reducing use of volatile agents. The main objective of this study is to evaluate the effectiveness of thoracic segmental spinal anesthesia in laparoscopic cholecystectomy.
Methods: This is a nonrandomized clinical trial. Patients aging 18-50 years with American Society of Anesthesia (ASA) class I or II undergoing elective laparoscopic cholecystectomy were included. The patients were given thoracic segmental spinal anaesthesia at the level of T9-T10 with 1 mL (5 mg) of 0.5% isobaric bupivacaine and 0.25 mL (25 mcg) fentanyl. Adequacy of block was assessed by clinical examination. Their vital parameters (HR, BP, SpO2) were recorded at regular interval. The satisfaction of both patients and surgeons were assessed by 5 points Likert scale.
Results: The average patient age was 41.9 ±4.9 years, with females comprising 20 (66.7%) and males 10 (33.3%). Most patients 18 (60%) were classified as ASA Class I, while 12 (40%) were Class II. Height, weight, and BMI showed moderate variability, indicating a relatively uniform group. Sensory blocks typically ranged from T4 to L2. Heart rate, SBP, DBP, and SpO2 were significantly affected during surgery, initially declining and later rising toward completion. The average duration of surgery was 40.2 ±6.4 minutes and duration of pneumoperitoneum was 29.6 ±5.5 minutes. The motor block lasted 67.3 ± 7 minutes, while sensory block was 100.1 ± 4.7 minutes. Postoperative pain was mild at 2 hours but reached its peak at 8 hours. The need for conversion to general anaesthesia was 2 (6.7%). However, perioperative complications such as bradycardia was 9 (30%), analgesic requirement was 6 (20%) and shoulder pain was 5 (16.7%). Both patients and surgeons reported high satisfaction, with a smaller group expressing neutrality or dissatisfaction.
Conclusions: Thoracic segmental spinal anaesthesia provides a reliable sensory and motor blockade and it could be an effective alternative technique for laparoscopic cholecystectomy surgery.