Open Cholecystectomy under Thoracic Segmental Spinal: A Case Series
Background and Aims: The thoracic segmental spinal approach of spinal anaesthesia is a safe and effective method for various surgeries, including open cholecystectomies, laparoscopic cholecystectomies, breast cancer lumpectomies, and abdominal cancer surgery. In this case series, we tried to demonstrate the effectiveness and safety of thoracic segmental spinal anaesthesia in patients underwent open cholecystectomy’ to ‘patients who underwent open cholecystectomy.
Materials and Methods: For this case series 10 patients who were posted for open cholecystectomy and gave consent were given thoracic segmental spinal anaesthesia with preservative-free 0.5% w/v isobaric levobupivacaine 10 mg with 5 mcg clonidine. The subarachnoid space puncture was performed via a median approach using a 25-gauge Quincke’s needle at T8-9 intervertebral space in the sitting position. After the injection patient was positioned supine and the level of the sensory blockade was tested using pinprick tests. Intraoperative hemodynamic changes were noted and postoperative follow-up until discharge was done.
Results: Intraoperative hypotension [mean arterial pressure(MAP)<65 mmHg] was documented only in four cases (40%), with one case (25%) of these requiring two boluses of phenylephrine. Intraoperative bradycardia [heart rate(HR)<60/min] was seen in 2 cases (20%) which required rescue drug with Injection atropine. Mean operative time was 45 mins, while the mean duration of spinal anaesthesia was 150 mins. No neurological complaints or consequences were noted in any case until discharge.
Conclusion: Thoracic segmental spinal anaesthesia is a safe and effective technique for upper abdominal and thoracic surgeries.
Keywords: Thoracic Segmental Spinal, General Anaesthesia, Upper abdominal and thoracic surgeries, Levobupivacaine, Clonidine, Open cholecystectomy
