Thoracic segmental spinal anaesthesia over general anaesthesia for gynaecologic laparoscopy surgeries

Kaushal Patel; Pinkal Patel; Rajesh Patel

doi:10.18203/2320-1770.ijrcog20252325

Authors

Kaushal Patel Department of Gynecology and Obstetrics, iSHA Hospital, Vapi, Gujarat, India
Pinkal Patel Department of Anaesthesiology, Community Health Centre Bhilad (Government of Gujarat), Valsad, Gujarat, India
Rajesh Patel Department of Anaesthesiology, Sai Krishna Hospital, Silvassa, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20252325

Keywords:

General anesthesia, Gynaecologic laparoscopy, Hemodynamic stability, Patient outcomes, Thoracic segmental spinal anesthesia

Abstract

Background: Gynaecologic laparoscopic procedures have traditionally relied on general anesthesia (GA), but thoracic segmental spinal anesthesia (TSSA) has emerged as a promising alternative. This research evaluates the efficacy, safety and patient outcomes when comparing TSSA to GA for gynaecologic laparoscopic surgeries.

Methods: A prospective randomized controlled trial (RCT) was done involving 126 patients scheduled for gynaecologic laparoscopy. Patients were allocated at random to the TSSA group (group.) (n=63) or the GA group. (n=63). Primary outcomes were hemodynamic stability, recovery profiles, post-operative pain scores and complications related to anesthesia. Secondary outcomes were patient satisfaction, cost evaluation and quality of surgical field visualization.

Results: TSSA provided superior hemodynamic stability with lower fluctuations in blood pressure along with heart rate (HR) (p<0.001). TSSA was associated with greatly lessened post-operative pain (p<0.001), faster recovery times (p<0.001), earlier ambulation (p<0.001) and lessened postoperative nausea and vomiting (PONV) (p<0.002). Patient satisfaction scores were higher in the TSSA group. (p<0.001), while cost analysis revealed a 66.18% drop in anesthesia-related expenses. Surgeon satisfaction regarding surgical field quality showed no noteworthy difference between techniques (p=0.34).

Conclusions: TSSA appears to be a secure and efficient alternative to GA for gynaecologic laparoscopic surgeries. It offers superior recovery profiles, enhanced patient comfort and economic benefits without compromising surgical conditions.

Metrics

Metrics Loading ...

References

Bajwa SJ, Kulshrestha A. Anaesthesia for laparoscopic surgery: General vs regional anaesthesia. J Min Access Surg. 2016;12(1):4-9. DOI: https://doi.org/10.4103/0972-9941.169952

Habib F, Khan E. Geriatric Ambulatory Patients. InGeriatric Anesthesia: A Practical Guide. Bentham Science Publishers. 2024: 226-243) DOI: https://doi.org/10.2174/9789815238877124010015

Kotekar N, Shenkar A, Hegde AA. Anesthesia issues in geriatrics. In Anesthesiology: A Practical Approach). Cham: Springer International Publishing. 2018: 795-825. DOI: https://doi.org/10.1007/978-3-319-74766-8_80

Cusack B, Buggy DJ. Anaesthesia, analgesia, and the surgical stress response. BJA Education. 2020;20(9):321-8. DOI: https://doi.org/10.1016/j.bjae.2020.04.006

Singh VK, Tiwari KK. General anesthesia vs. segmental spinal anesthesia: Hemodynamic stability and ease of doing surgery in laparoscopic cholecystectomy. International J Life Sci, Biotechnol Pharma Res. 2025:14(5):301-8.

Levy L, Tsaltas J. Recent advances in benign gynecological laparoscopic surgery. Faculty Rev. 2021;10:60. DOI: https://doi.org/10.12703/r/10-60

Haloi P, Biswas R, Bora A. Efficacy of thoracic segmental spinal anaesthesia in percutaneous nephrolithotomy: a retrospective observational study. J Clin Diagnos Res. 2024;18(4):71. DOI: https://doi.org/10.7860/JCDR/2024/68910.19307

Fu G, Xu L, Chen H, Lin J. State-of-the-art anesthesia practices: a comprehensive review on optimizing patient safety and recovery. BMC Surg. 2025;25(1):32. DOI: https://doi.org/10.1186/s12893-025-02763-6

Singhal G, Kaur P. Comparison of hemodynamic changes in thoracic segmental spinal anaesthesia and general anaesthesia for laparoscopic cholecystectomy. Indian J Clin Anaesth. 2024;11:125-31.

Warta KA, Lu X, Nguyen TD, Shakar RM, Beste TM. Spinal anesthesia prior to laparoscopic hysterectomy resulted in decreased postoperative pain and opioid use. J Soc Laparos Rob Surg. 2023;27(4):50. DOI: https://doi.org/10.4293/JSLS.2023.00050

Koning MV, Teunissen AJ, van der Harst E, Ruijgrok EJ, Stolker RJ. Intrathecal morphine for laparoscopic segmental colonic resection as part of an enhanced recovery protocol: a randomized controlled trial. Regional Anest Pain Med. 2018;43(2):166-73. DOI: https://doi.org/10.1097/AAP.0000000000000703

Warda G. Efficacy of antiemetic drugs in preventing nausea and vomiting in patients undergoing general anesthesia: a systematic review. Acad Med Surg. 2024;3:652. DOI: https://doi.org/10.62186/001c.120231

Li XY, Tian M, Li AZ, Han CL, Li KZ. The risk of shoulder pain after laparoscopic surgery for infertility is higher in thin patients. Scientific Reports. 2021;11(1):13421. DOI: https://doi.org/10.1038/s41598-021-92762-3

Joshipura VP, Haribhakti SP, Patel NR, Naik RP, Soni HN, Patel B, et al. A prospective randomized, controlled study comparing low pressure versus high pressure pneumoperitoneum during laparoscopic cholecystectomy. Surg Laparosc Endos Percut Techn. 2009;19(3):234-40. DOI: https://doi.org/10.1097/SLE.0b013e3181a97012

Graff V, Gabutti L, Treglia G, Pascale M, Anselmi L, Cafarotti S, et al. Perioperative costs of local or regional anesthesia versus general anesthesia in the outpatient setting: a systematic review of recent literature. Brazilian J Anesthesiol. 2023;73(3):316-39. DOI: https://doi.org/10.1016/j.bjane.2021.09.012