Abstract

GONIMA, Edmundo; MARTINEZ, Juan Carlos  and  PERILLA, Claudia. Anestesia general vs. peridural en colecistectomía laparoscópica. Rev. colomb. anestesiol. [online]. 2007, vol.35, n.3, pp.203-213. ISSN 0120-3347.

Objective: This study was designed to establish the differences between general and peridural anesthesia in laparoscopic colecistectomy. Methods: Randomized clinical trial. Participants: 52 patients, ASA 1 and 2 programmed for laparoscopic colecistectomy at the Clínica Universitaria Teletón. Both groups received premedication with dipirona, ondansetron and dexametasona. In the group assigned to peridural anesthesia punction was carried out at the T9-T10 level, anesthesia with 2% lidocain with epinephrine (100 mg) and 0.5% bupivacain without epinephrine, 25 mg, leaving peridural catheter. Transoperatory Sedation was done with with remifentanyl. To the group with general anesthesia was practiced a conventional induction with Propofol, Remifentanil and Rocuronio. Anesthetic maintenance with Remifentanil in infusion and Sevofluorano. Orotraqueal intubation. Transoperative analgesia in both groups with morphine. Subdiafragmatic instilation of Bupivacaina 0.25% in both groups. Postoperative analgesia with Tramadol and Acetaminofen. Vital signs during transoperative process were evaluated in both groups. In the group of peridural anesthesia, presence of abdominal pain, back pain, shoulder pain, nausea, vomit and breathing difficulty in the transoperatory period were evaluated. In the postoperative for two groups the presence in surgical wound, shoulder pain, back pain, nausea, vomit, migraine, breathing difficulty at times of 0, 30, 60, 90 minutes, 6, 24 and 72 hours were evaluated too. Total requirements of morphine in the postoperative period were registered. Results: Significant differences were presented in the values of Sat O2 (p <0.05) which were smaller in the group of peridural and CO2 (p <0.05) that increased significantly from the dissection of the vesicle until the end of the surgery in the group of peridural 13% of the cases with peridural anesthesia required conversion to general anesthesia. In the group of peridural anesthesia the shoulder pain was the most frequent nuisance (80%). The postoperative pain in the surgical place was smaller in the group of peridural at 0, 30 and 60 min (p <0.05); in the other evaluated times there was any difference among the groups. As for back pain and of shoulder significant differences were not presented in the postoperative period; the same thing happened to the requirements of morphine. The values of Cortisol increased significantly with regard to the basal ones in the group of peridural (p <0.05). In conclusion, we are describing an anesthetic technique that is not used frecuently for laparoscopic colecistectomy. We were able to maintain our patients inside some allowed limits of security and of well-being during trans and postoperative period. We didn’t have complications to complain neither left out of the common of anesthetic practice. We could demonstrate the decrease of the postoperative pain in the first hour in the group of peridural but we could not diminish the requirements of morphine significantly and neither we could diminish the metabolic answer to the stress with the regional anesthesia. We accept that the general anesthesia is the anesthetic technique of election for laparoscopic colecistectomy in most of patients but we also understand that peridural anesthesia is a possible alternative for those whose risk imposes the election of another technique different to the general one.

Keywords : Laparoscopic colecistectomy; general anesthesia; peridural anesthesia.

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