A case series of use of combined spinal epidural anesthesia for laparoscopic appendectomy in adults

Background: Most of the surgeries are now-a-days performed laproscopically. Early ambulation, less infections, cosmetic effects, minimal surgical pain are some of the advantages of laproscopic surgeries over open surgeries. General anesthesia is usually used to prevent aspiration and respiratory compromise seen secondary to pneumoperitoneum created in laproscopic surgeries. But general anesthesia does not provide post-operative analgesia. Also, general anesthesia has disadvantage of decreasing FRC and TV. Regional anesthesia provides good postoperative analgesia, anti-emesis with minimal respiratory and cardiovascular changes. In regional anesthesia patient is awake and oriented during surgery, also problems like oral or theeth injury during laryngoscopy, sore throat and stomach inflation seen in general anesthesia can be avoided. Regional anesthesia is safe and cost effective as compared to general anesthesia. Methods: Eight ASA grade I and II patients undergoing elective Laparoscopic appendectomy were performed under combined spinal epidural anesthesia. Spinal anesthesia was given at L2-L3 interspace using 3.5 ml of 0.5% (17.5 mg) hyperbaric Bupivacaine mixed with 0.5ml (25 micrograms) of Fentanyl. Epidural catheter was inserted at T10-T11 interspace for inadequate spinal anesthesia and postoperative pain relief. Perioperative events and operative difficulty event was noted. Systemic drugs were administered if patients complained of shoulder pain, abdominal discomfort, nausea or hypotension. Results: Spinal anesthesia was adequate for surgery with no operative difficulty in all the patients. Intraoperatively, two patients experienced right shoulder pain and was given Fentanyl, one patient was given Midazolam for anxiety and two were given mephentermine for hypotension. The postoperative period was uneventful. Conclusion: Spinal anesthesia with hyperbaric Bupivacaine and Fentanyl is adequate and safe for elective laparoscopic appendectomy in healthy patients and a better alternative to general anesthesia.