Efficacy of Combined Epidural-General Anaesthesia [CEGA] in Attenuating Hemodynamic Responses to Pneumoperitoneum in Laparoscopic Cholecystectomies: A Prospective Randomised Study

Nethra H Nanjundaswamy; Sudheesh Kannan; Vijaykumar H Narayanappa; Saraswathi Nagappa; Sandya Kalappa

doi:10.18502/aacc.v9i6.14447

Nethra H Nanjundaswamy Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India.
Sudheesh Kannan Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India.
Vijaykumar H Narayanappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India.
Saraswathi Nagappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India.
Sandya Kalappa Bangalore Medical College and Research Institute, Departmentof Anaesthesiology, Victoria Hospital, Bangalore, India.

DOI: https://doi.org/10.18502/aacc.v9i6.14447

Keywords: Epidural; General anaesthesia; Combined Epidural-General Anaesthesia (CEGA); Laparoscopy; Cholecystectomy; Efficacy

Abstract

Background: Pnuemoperitonium in laparoscopy is associated with cardiorespiratory changes. Combination of epidural with General anaesthesia (GA) will offer benefit of hemodynamic control and perioperative analgesia. We aimed to study the efficacy of Combined Epidural- General Anaesthesia (CEGA) with pre-emptive activation over general anaesthesia in laparoscopic cholecystectomies.

Methods: In this prospective double blind –randomised study, 90 surgical inpatients were studied in two study groups. Group GE-(n=45) received Lumbar Epidural analgesia with ropivacaine 0.2% along with GA and Group G (n=45) received only GA. Heart rate (HR), Mean arterial Pressure (MAP), systolic blood pressure (SBP), diastolic blood pressure (DBP), Capnogram (ETCO2), saturation (spo2), VAS score, Ramsay sedation score, requirement of propofol, muscle relaxants and analgesics were studied.

Results: Statistical analysis was carried out with SPSS version 20. Statistical value of p<0.05 was considered significant. We noted significant difference in MAP, SBP, DBP, muscle relaxants, Propofol, Fentanyl and lesser pain scores in Group GE than Group G i.e (p<0.001).

Conclusion: Combination of epidural and general anaesthesia technique with pre emptive activation has the benefit of better control of hemodynamics .It reduced requirements of analgesics and anaesthetic drugs and had faster recovery with less post operative pain in laparoscopic cholecystectomies.