EPIDURAL ANAESTHESIA;

COMPARISON AS AN ALTERNATIVE TO GENERAL ANAESTHESIA IN OPEN CHOLECYSTECTOMY

Abstract

Objective: To compare the, post op analgesia, vomiting, shivering, length of hospital stay, peri-operative haemodynamic
changes and recovery time in patient under going open cholecystectomy under general anaesthesia versus those receiving epidural
anaesthesia. Study design: Quasi experimental study. Place and duration of study: Combined Military Hospital Rawalpindi from 15 October
2007 to 15 April 2008. Methodology: American Society of Anaesthesiology (ASA) physical status (PS) I and II patient of either gender
undergoing un-complicated open cholecystectomy were randomly divided into two groups, group A (n=30) received general anaesthesia (GA)
and group B (n=29) received thoracic epidural anaesthesia (EA). Patients of both the groups were assessed for peri-operative haemodynamic
changes, recovery time, post op analgesia, vomiting and length of hospital stay. Chi-square test was applied to compare the two groups and
obtain P-value. P-value of less than 0.05 was considered significant. Results: 9 out of 30 patients (30%) of group “A” (general anaesthesia) and
4 out of 29 patients (13.79%) in group “B” (epidural anaesthesia) had vomiting. Shivering was seen in 3 out of 30 (10%) in group “A” (general
anaesthesia) and 1 out of 29 (3.44%) patient in group “B” (epidural anaesthesia). Urinary retention was seen in 1 out of 30 (3.33%) in group “A”
(general anaesthesia) and 8 out of 29 (27.5%) in group “B” (epidural anaesthesia). Urinary retention was relieved by psychotherapy. None of
the patient required catheterization. Post operative recovery from surgery was determined by gastrointestinal motility (passage of flatus and
start of oral sips). In group “A” (general anaesthesia) 6 patients (20%) started oral sips in first post operative day, 16 patients (53.33%) on
second post operative day, 8 patients (26.66%) in third post operative day. In the group “B” (epidural anaesthesia) 13 patients (44.8%) started
oral sips on first post operative day, 15 (51.72%) on second post operative day and one patient (3.44%) on third post operative day. Regarding
the length of hospital stay 17 patient (56.66%) of group “A” (general anaesthesia) were discharge by third post operative day and 22 patient
(75.77) were discharge by third post operative day in group “B” (epidural anaesthesia). Conclusions: The use of intra-operative epidural
anaesthesia combined with postoperative epidural analgesia was found to be associated with reduction in the post operative pain and vomiting
in patients under going open cholecystectomy.