TMSS Medical College Journal

Background: Open cholecystectomy is now routinely done in district level hospitals in our country. Both general anesthesia (GA) and spinal sub-arachnoid block (SAB) can be used for this. GA has some side effects, costly, needs expertise and apparatus. SAB is cheap and has less complications. Objective: The objective of this study is to find out the suitability of GA and SAB in district level hospital. Materials and Methods: In this prospective study, total 90 cases were included and all were admitted in 250 Bedded General Hospital, Naogaon between January 2019 and December 2020. All cases were divided into two groups. In group GA 45 cases were operated under GA and in group SAB another 45 cases were operated under SAB. Data were collected in a pre-designed questionnaire and analyzed by computer based software and results were presented in tabulated form. Results: Each group had 43 patients. Mean age were 42.3+12.17 years and 41.4+11.8 years in GA group and SAB group respectively. 75.6% were male in GA group and 80% in SAB group. 71.1% and 66.7% cases in ASA Grade I in GA and SAB group respectively. In GA group, 37.8% had diabetes mellitus, 33.3% had hypertension and in SAB group, it were 33.3% and 26.7% respectively. In GA group, mean duration of surgery was 24.8+1.2 minutes with 39.64+4.39 minutes total elapsing time. In SAB group it were 23 46£2.02 minutes and 35.64+2.3 minutes respectively. In GA group, 57.8% had shoulder pain, 22.2% had PONV and no patient had headache or urinary retention. But in SAB group, 13.3% had urinary retention and 8.9% had headache. SAB patients had more pain at 6 hour postoperatively. Average cost of anesthetic drugs in SAB was 142.22+13.80 taka and that of GA was 1220+42.50 taka. Conclusion: As SAB has less complications, needs less expertise and remarkably cheap. It is more preferable than GA at district level hospitals in Bangladesh.

Laparoscopic approach is the standard choice for cholecystectomy.! But in our country specially at district and upazilla level open cholecystectomy is still done routinely due to lack of access to necessary equipment, shortage of expert manpower and patient's financial condition is also an important factor. In our country, for open cholecystectomy anesthesiologists use mainly two types of anesthesia- General Anesthesia (GA) and Spinal Subarachnoid Block (SAB). Though GA is the gold standard® it needs special care and expertize for intubation and also needs special equipments. This procedure is also costly as it uses several drugs including gases. There are some drawbacks of GA. These are basal atelectasis, post-operative paralytic ileus, aspiration of gastric contents, longer stay time at post-operative ward and increased mortality and morbidity. On the other hand, SAB provides selective blockade of surgical site and has some advantages. In SAB, patient can maintain spontaneous respiration (no need of artificial ventilation), reduced incidence of paralytic ileus, creates some hypotension that reduces wound bleeding and above all it is relatively cheap as it needs few drugs and no extra instruments.’ The disadvantages are- a challenge to face hypotension and rarely accidental high blockade that may need ventilation. The present study was done to compare the suitability of GA and SAB for open cholecystectomy in district level hospitals in terms of post-operative pain free interval and analgesic requirement, costing, patients’ and surgeons’ satisfactions.