• Luiz Eduardo Imbelloni, Marcos Fornasari, José Carlos Fialho, Raphael Sant'Anna, and José Antonio Cordeiro.
• Hospital Rio Laranjeiras, Rio de Janeiro, RJ.
• Rev Bras Anestesiol. 2010 May 1; 60 (3): 217-27.

Background And ObjectivesLaparoscopic cholecystectomy is the treatment of choice for cholelithiasis. The objective of this study was to compare the possibility of performing laparoscopic cholecystectomy under spinal anesthesia versus general anesthesia.MethodsBetween July 2007 and September 2008, 68 patients with symptoms of cholelithiasis were included in this study. Patients with physical status ASA I and II were randomly divided to undergo laparoscopic cholecystectomy with low-tension pneumoperitoneum with CO(2) under general anesthesia (n = 33) or spinal anesthesia (n = 35). Propofol, fentanyl, rocuronium, sevoflurane, and tracheal intubation were used for general anesthesia. Hyperbaric bupivacaine 15 mg, and fentanyl 20 microg to achieve a sensorial level of T(3) were used for the spinal anesthesia. Intraoperative parameters, postoperative pain, complications, recovery, patient satisfaction, and cost were compared between both groups.ResultsAll surgical procedures were completed with the chosen method and spinal anesthesia was converted to general anesthesia only in one patient. Pain was significantly lower at 2, 4, and 6 hours after the procedure under spinal anesthesia. The cost of the spinal anesthesia was significantly lower than that of the general anesthesia. All patients were discharged after 24 hours. In the postoperative evaluation, all patients were satisfied with the spinal anesthesia and would recommend this procedure.ConclusionsLaparoscopic cholecystectomy with low-pressure pneumoperitoneum with CO(2) can be safely performed under spinal anesthesia. Spinal anesthesia was associated with an extremely low level of postoperative pain, better recovery, and lower cost than general anesthesia.Copyright 2010 Elsevier Editora Ltda. All rights reserved.

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