Abstract :
Background and Aims: Total laparoscopic hysterectomy (TLH) is typically performed under general anesthesia (GA). However, thoracic spinal anesthesia (TSA) may serve as a valuable alternative, especially for high-risk patients. This randomized controlled trial aimed to compare the efficacy and safety of GA and TSA in patients undergoing TLH.
Materials and Methods: Sixty patients scheduled for elective TLH were randomized into group T (TSA) and group G (GA) of thirty patients each. Group G received conventional GA with intubation and mechanical ventilation while group T received TSA (sub-arachnoid block at T8/9 or T9/10 with hyperbaric levo-bupivacaine 0.5%, 0.7ml along with dexmedetomidine 4µg followed by isobaric levo-bupivacaine 0.5% 1.5 ml with dexmedetomidine 6µg µg in sitting position).Our primary aim was to compare the hemodynamic variations and secondary aim was to compare intra-operative and post-operative adverse effects and requirement of rescue analgesia between the two techniques.
Results: All 60 patients were analyzed for study. Group T patients showed greater hemodynamic stability with notably significant differences in mean SBP between the two groups after 30 minutes (at 40 minutes p=0.043, at 60 minutes p=0.007). The patients requiring rescue analgesia were significantly more in group G. Adverse events like intra-operative hypertension and post operative sore throat were more in group G.
Conclusion: TSA provides a safe alternative to GA for TLH with better hemodynamic stability, fewer side effects and lesser requirement of rescue analgesia.
Keyword :
Thoracic spinal anesthesia, Total laparoscopic hysterectomy, General anesthesia, Pneumoperitoneum.