Keywords
Cholecystectomy; Local anesthesia; Spinal anesthesia; Epidural anesthesia; Minimally invasive surgery
Abstract
Background: Reports of cholecystectomy under local or regional anesthesia are rare. Nevertheless, it can be a useful tool in selected patients with high risk or unwillingness for general anesthesia. An updated review of the cases published in the medical literature was conducted.
Method: The Medline/PubMed database and the Medical Subject Headings (MeSH) vocabulary were used to search original articles regarding cholecystectomy under local or regional anesthesia. The main terms used for the literature review were: “local anesthesia”, “spinal anesthesia”, “epidural anesthesia”, “nerve block” and “cholecystectomy”.
Findings: In regard to local anesthesia, four studies were found with a total of 125 patients in which an open cholecystectomy was performed under local anesthesia plus sedation through a small abdominal incision. Operative duration varies from 40 to 101 minutes. Regarding regional anesthesia 14 studies, all using a laparoscopic approach, were included in our review. The most common complications of this approach were severe shoulder pain (6-55% of patients) and hypotension (5-59% of patients). An inconvenience of all these procedures is the occasional need for conversion into general anesthesia (up to 37%). When reported, patient satisfaction is 100%.
Conclusion: Cholecystectomy under local or regional anesthesia plus sedation can be a safe and feasible procedure in selected patients, when there is a high risk or unwillingness for general anesthesia.
Citation
Carlin SP, Panova DT and Giner M. Alternatives to General Anesthesia for Cholecystectomy: A Review. SM Min Inv Surg. 2017; 1(1): 1005.