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Epidural versus general anesthesia for laparo-endoscopic single-site cholecystectomy: a randomized controlled trial

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Abstract

Introduction

This study compares outcomes after LESS cholecystectomy utilizing epidural versus general anesthesia.

Methods

Patients undergoing LESS Cholecystectomy were randomized into receiving epidural or general anesthesia by protocol. Patients used a Visual Analog Scale to rate pain from 0 (no pain) to 10 (severe pain). Data presented as median (mean ± standard deviation).

Results

75 patients underwent LESS cholecystectomy with general anesthesia [32 patients (22% men) after five patients withdrew consent] or epidural anesthesia [23 patients (22% men) after 15 patients withdrew consent]. Respectively, they were of age 38 years (41 ± 15.1) and 47 years (48 ± 13.9), BMI 29 (28 ± 4.9) kg/m2 and 28 (28 ± 3.8) kg/m2, and ASA 2 (2 ± 0.5) and 2 (2 ± 0.3) (p > 0.05 for all). LOS for patients receiving general vs. epidural anesthesia was 72 min (122 ± 104.4) vs. 95 min (113 ± 77.5) (p = 0.25). On POD 0, patients receiving general anesthesia rated pain as 4 (4 ± 2.9) vs. 0 (1 ± 2.2) for epidural anesthesia (p = 0.02). On POD 1, they rated pain as 6 (5 ± 2.3) vs. 6 (6 ± 2.9) (p = 0.68). On POD 6, patients rated pain as 3 (3 ± 2.7) vs. 4 (3 ± 2.2) (p = 1.00). For patient satisfaction with incisional scars for those receiving general vs. epidural anesthesia, patients rated their scars to be 10 (8 ± 3.6) vs. 10 (9 ± 1.2) (p = 0.21). Total costs for the hospital using general vs. epidural anesthesia were found $6,909 (7,167 ± 2,083.8) vs. $6,225 (5,848 ± 1530.1) (p = 0.014), respectively. Patients self-assessed satisfaction on a scale of 1 (worst) to 5 (best) as a 5 (5 ± 0).

Conclusions

Patients undergoing LESS cholecystectomy with general vs. epidural anesthesia had similar demographics, LOS, and pain scores. Patients that received epidural anesthesia reported less pain and incurred less cost. Utilization of epidural anesthesia in lieu of general anesthesia for LESS cholecystectomy is safe, reduces pain, and offers potential cost savings.

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Authors and Affiliations

  1. Digestive Health Institute AdventHealth Tampa, Tampa, FL, USA

    Sharona B. Ross, Maria Christodoulou, Nicole Ross, Iswanto Sucandy, Kenneth Lubrice, Sneha Saravanan & Alexander Rosemurgy

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  1. Sharona B. Ross
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  2. Maria Christodoulou
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  3. Nicole Ross
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  4. Iswanto Sucandy
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  5. Kenneth Lubrice
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  6. Sneha Saravanan
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  7. Alexander Rosemurgy
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Correspondence to Sharona B. Ross.

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Disclosures

Dr. Sharona B. Ross is a consultant for Intuitive Surgical (Sunnyvale, CA) and Ethicon (Cincinnati, OH). Dr. Sharona B. Ross receives educational grants for the Women in Surgery Career Symposium from Intuitive Surgical and Medtronic (Minneapolis, MN). Maria Christodoulou, Nicole Ross, Iswanto Sucandy, Kenneth Lubrice, Sneha Saravanan, and Alexander Rosemurgy have no conflicts of interest or financial ties to disclose.

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Ross, S.B., Christodoulou, M., Ross, N. et al. Epidural versus general anesthesia for laparo-endoscopic single-site cholecystectomy: a randomized controlled trial. Surg Endosc 38, 1414–1421 (2024). https://doi.org/10.1007/s00464-023-10628-3

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  • DOI: https://doi.org/10.1007/s00464-023-10628-3

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