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Regional anesthesia for laparoscopic surgery: a narrative review

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Abstract

Laparoscopic surgery has advanced remarkably in recent years, resulting in reduced morbidity and shorter hospital stay compared with open surgery. Despite challenges from the expanding array of laparoscopic procedures performed with the use of pneumoperitoneum on increasingly sick patients, anesthesia has remained largely unchanged. At present, most laparoscopic operations are usually performed under general anesthesia, except for patients deemed “too sick” for general anesthesia. Recently, however, several large, retrospective studies questioned the widely held belief that general anesthesia is the best anesthetic method for laparoscopic surgery and suggested that regional anesthesia could also be a reasonable choice in certain settings. This narrative review is an attempt to critically summarize current evidence on regional anesthesia for laparoscopic surgery. Because most available data come from large, retrospective studies, large, rigorous, prospective clinical trials comparing regional vs. general anesthesia are needed to evaluate the true value of regional anesthesia in laparoscopic surgery.

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Abbreviations

ASA-PS:

American Society of Anesthesiologists Physical Status

CSEA:

Combined spinal–epidural anesthesia

EA:

Epidural anesthesia

GA:

General anesthesia

LIA:

Local infiltration anesthesia

LC:

Laparoscopic cholecystectomy

PONV:

Postoperative nausea and vomiting

RA:

Regional anesthesia

RCT:

Randomized controlled trial

SA:

Spinal anesthesia

TEA:

Thoracic epidural anesthesia

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Acknowledgments

This study is attributable to the University Hospital of Larissa, Greece.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, University Hospital of Larissa, Larissa, Greece

    George Vretzakis & Metaxia Bareka

  2. Department of Anaesthesiology, Pyrgos General Hospital, 76 Stratigou Konstantinopoulou St, Aroi, 26331, Patras, Greece

    Diamanto Aretha

  3. Department of Anesthesiology, Washington University School of Medicine, St. Louis, MO, USA

    Menelaos Karanikolas

Authors
  1. George Vretzakis
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  2. Metaxia Bareka
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  3. Diamanto Aretha
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  4. Menelaos Karanikolas
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Corresponding author

Correspondence to Diamanto Aretha.

Additional information

The search strategy used to find relevant references in PubMed is given as Appendix.

Appendix: Search strategy for PubMed

Appendix: Search strategy for PubMed

  1. 1.

    Analgesia Epidural [MeSH]

  2. 2.

    Anesthesia Epidural [MeSH]

  3. 3.

    Anesthesia Local [MeSH]

  4. 4.

    Anesthesia Spinal [MeSH]

  5. 5.

    Cholecystectomy [MeSH]

  6. 6.

    Laparoscopic [MeSH]

  7. 7.

    Laparoscopy [MeSH]

  8. 8.

    Surgery [MeSH]

  9. 9.

    #1 and #7 or #1 and #6 and #8 or #1 and 5

  10. 10.

    #2 and #7 or #2 and #6 and #8 or #2 and 5

  11. 11.

    #3 and #7 or #3 and #6 and #8 or #3 and 5

  12. 12.

    #4 and #7 or #4 and #6 and #8 or #4 and 5

  13. 13.

    PubMed advance search: ((((((((((epidural) OR spinal) OR intrathecal) OR subarachnoid) OR local) OR regional) AND anesthesia) OR anaesthesia)) AND laparoscopic) AND surgery

  14. 14.

    PubMed advance search: (((((((((regional) OR epidural) OR spinal) OR local) OR neuraxial) AND anesthesia) OR anaesthesia)) AND laparoscopy

  15. 15.

    PubMed advance search: (((((((((((local) OR regional) OR epidural) OR spinal) AND anesthesia) OR anaesthesia)) AND postoperative) AND pain) AND laparoscopic) AND surgery

  16. 16.

    PubMed advance search: ((((((((((((local) OR regional) OR epidural) OR spinal) AND anesthesia) OR anaesthesia)) AND postoperative) AND pain)) AND laparoscopy. The search strategies for MEDLINE, Embase, and Cochrane were similar.

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Vretzakis, G., Bareka, M., Aretha, D. et al. Regional anesthesia for laparoscopic surgery: a narrative review. J Anesth 28, 429–446 (2014). https://doi.org/10.1007/s00540-013-1736-z

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  • DOI: https://doi.org/10.1007/s00540-013-1736-z

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