Feasibility of Local Anaesthesia in Various Upper Abdominal Surgical Procedures; A Tertiary Care Hospital Study: Feasibility of Local Anesthesia in Various Upper Abdominal Surgical Procedures

Muhammad Azeem Gulzar; Muhammad Raza; Salma Parveen; Anum Shahid; Sana Naseem

doi:10.37978/tijfs.v6i1.341

Authors

Muhammad Azeem Gulzar Sir Ganga Ram Hospital, Lahore, Pakistan Author https://orcid.org/0000-0002-3237-5339
Muhammad Raza Nishtar Hospital, Multan, Pakistan Author
Salma Parveen Sir Ganga Ram Hospital, Lahore, Pakistan Author
Anum Shahid Sir Ganga Ram Hospital, Lahore, Pakistan Author
Sana Naseem Sir Ganga Ram Hospital, Lahore, Pakistan Author https://orcid.org/0009-0009-6827-6736

DOI:

https://doi.org/10.37978/tijfs.v6i1.341

Keywords:

Anesthesia, Local Anesthesia, General Anesthesia, Post operative nausea and vomiting, Thoracic Surgery

Abstract

Background: This study was conducted to evaluate the feasibility of local anesthesia (LA) instead of general anesthesia (GA) in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting.

Materials and Methods: This study was conducted at Thoracic surgery department, Nishtar Hospital Multan, Pakistan from September,1^st-December,31^st,2020. Out of 147 patients 80 and 67 patients were operated under LA and GA respectively. Age, BMI, gender, procedure performed, etiology, mean time, stay in recovery, PONV, postoperative pain at 4, 8, 12 hours, postoperative sedation and discomfort, within 3-and 7-days postoperative mortality were documented and compared between the two groups.

Results: Mean age of the patients in group LA was significantly higher as compared to group GA(p<0.001). Procedure time was 30.06±12.01minutes and 34.42±11.76minutes (p=0.029), mean duration of stay in recovery was 2.31±5.68minutes and 18.80±6.40minutes(p<0.001) in group LA and GA, respectively(p=0.029). Postoperative discomfort was also higher in group GA as compared to group LA(p=0.001). The incidence of PONV was 12.5% and 35.8% in group LA and GA, respectively(p=0.001). Complaint of postoperative pain was 16.2% and 37.3% at 4 hours(p=0.004); 18.8% and 35.8% at 8 hours(p=0.020); and 21.2% and 26.9% at 12 hours(p=0.426) in group LA and GA, respectively.

Conclusion: For performing various upper abdominal procedures, LA is safe for the patients who are medically unfit for GA. Moreover, LA is associated with lesser adverse effects as compared

to GA. Patient is more comfortable and there is better pain relief in early postoperative period.

References

Verma R, Mohan B, Attri JP, Chatrath V, Bala A, Singh M. Anesthesiologist: The silent force behind the scene. Anesth Essays Res. 2015;9(3):293-97. doi: 10.4103/0259-1162.159775 DOI: https://doi.org/10.4103/0259-1162.159775

John ER, Prichep LS, inventors; New York University, assignee. System and Method for Guidance of Anesthesia, Analgesia and Amnesia. United States patent application US 15/174,476. 2016. https://patents.google.com/patent/US9357965B2/en

Jabbar A, Khurana A, Mohammed A, Das R, Zaman A, Edwards R. Local versus general anesthesia in transcatheter aortic valve replacement. Am J Cardiol. 2016;118(11):1712-16. https://doi.org/10.1016/j.amjcard.2016.08.051 DOI: https://doi.org/10.1016/j.amjcard.2016.08.051

Lee JH, Zhang J, Wei L, Yu SP. Neurodevelopmental implications of the general anesthesia in neonate and infants. Exp Neurol. 2015;272:50-60. https://doi.org/10.1016/j.expneurol.2015.03.028 DOI: https://doi.org/10.1016/j.expneurol.2015.03.028

Checketts MR. AAGBI recommendations for standards of monitoring during anesthesia and recovery 2015. Anesthesia. 2016;71(4):470-71. doi:10.1111/anae.13428 DOI: https://doi.org/10.1111/anae.13421

Qiao Y, Feng H, Zhao T, Yan H, Zhang H, Zhao X. Postoperative cognitive dysfunction after inhalational anesthesia in elderly patients undergoing major surgery: the influence of anesthetic technique, cerebral injury and systemic inflammation. BMC Anesthesiol. 2015;15(1):154. https://doi.org/10.1186/s12871-015-0130-9 DOI: https://doi.org/10.1186/s12871-015-0130-9

Sessler DI. Perioperative thermoregulation and heat balance. The Lancet. 2016;387(10038):2655-64.https://doi.org/10.1016/S0140-6736(15)00981-2 DOI: https://doi.org/10.1016/S0140-6736(15)00981-2

Srivastava S, et al. Cortisol lowering action and cardiovascular stability of etomidate: a comparison with propofol in controlled hypertensives. J Evol Med Dent Sci. 2015;4(75):13016-24. DOI:10.14260/jemds/2015/1876 DOI: https://doi.org/10.14260/jemds/2015/1876

Yeh DD, Martin M, Sakran JV, Meier K, Mendoza A, Grant AA, et al. Advances in nutrition for the surgical patient. Current problems in surgery. 2019;56(8):343-98. DOI: 10.1067/j.cpsurg.2019.04.003 DOI: https://doi.org/10.1067/j.cpsurg.2019.04.003

Catterall WA, Mackie K. Local anesthetics. InGoodman& Gilman's the pharmacological basis of therapeutics 2011 (pp. 565-82). McGraw-Hill, New York (NY).http://www.academia.edu/download/63166997/Goodman___Gilman_Pharmacology20200501-67374-3ndhg6.pdf#page=590

Sethi S, Richter JE. Non-Reflux-Mediated Esophageal Strictures. InEvaluation and Management of Dysphagia 2020 (pp. 81-104). Springer, Cham. https://doi.org/10.1007/978-3-030-26554-0_5 DOI: https://doi.org/10.1007/978-3-030-26554-0_5

Munandar MA, Fauzi AR, Simanjaya S, Damayanti W. Gastric stricture following corrosive agent ingestion: A case report. Int J Surg Case Rep. 2020;75:539-42. https://doi.org/10.1016/j.ijscr.2020.09.067 DOI: https://doi.org/10.1016/j.ijscr.2020.09.067

El-Asmar KM, Allam AM. Surgical management of corrosive-induced gastric injury in children: 10 years' experience. J Pediatr Surg. 2018;53(4):744-47. https://doi.org/10.1016/j.jpedsurg.2017.05.014 DOI: https://doi.org/10.1016/j.jpedsurg.2017.05.014

Pop R, Severac F, Ngankou EH, Harsan O, Martin I, Mihoc D, et al. Local anesthesia versus general anesthesia during endovascular therapy for acute stroke: a propensity score analysis. Journal of NeuroInterv Surg. 2021;13(3):207-11. http://dx.doi.org/10.1136/neurintsurg-2020-015916 DOI: https://doi.org/10.1136/neurintsurg-2020-015916

Huppelschoten AG, Bijleveld K, Braams L, Schoot BC, van Vliet HA. Laparoscopic sterilization under local anesthesia with conscious sedation versus general anesthesia: Systematic review of the literature. J Minimal Inv Gynecol. 2018;25(3):393-401. https://doi.org/10.1016/j.jmig.2017.11.010 DOI: https://doi.org/10.1016/j.jmig.2017.11.010

Bach JR, Gonzalez M, Sharma A, Swan K, Patel A. Open gastrostomy for noninvasive ventilation users with neuromuscular disease. Am J Phys Med Rehab. 2010;89(1):1-6. doi: 10.1097/PHM.0b013e3181c55e2c DOI: https://doi.org/10.1097/PHM.0b013e3181c55e2c

Faizer R, Weinhandl E, El Hag S, Le Jeune S, Apostolidou I, Shafii SM, et al. Decreased mortality with local versus general anesthesia in endovascular aneurysm repair for ruptured abdominal aortic aneurysm in the Vascular Quality Initiative database. J Vasc Surg. 2019;70(1):92-101.https://doi.org/10.1016/j.jvs.2018.10.090 DOI: https://doi.org/10.1016/j.jvs.2018.10.090

Mouton R, Rogers CA, Harris RA, Hinchliffe RJ. Local anesthesia for endovascular repair of ruptured abdominal aortic aneurysm. J Brit Surg. 2019;106(1):74-81.https://doi.org/10.1002/bjs.10973 DOI: https://doi.org/10.1002/bjs.10973

Kim MS, Kim BH, Han YE, Nam DW, Hah JH. Clinical outcomes after local anesthesia with monitored anesthesia care during thyroidectomy and selective neck dissection: a randomized study. Eur Arch Oto Rhino Laryngol. 2017;274(10):3789-94.DOI: https://doi.org/10.1007/s00405-017-4707-4 DOI: https://doi.org/10.1007/s00405-017-4707-4

LeBlanc K, Sweitzer SM. Systematic Review of Clinical Evidence for Local Anesthetic Wound Infiltration in Reduction of Post-Surgical Pain. Intern Med. 2015;5(207):2. DOI:10.4172/2165-8048.1000207 DOI: https://doi.org/10.4172/2165-8048.1000207

Sun JX, et al. Effect of local wound infiltration with ropivacaine on postoperative pain relief and stress response reduction after open hepatectomy. World J Gastroenterol. 2017;23(36):6733-40. doi: 10.3748/wjg.v23.i36.6733 DOI: https://doi.org/10.3748/wjg.v23.i36.6733

Rerkasem K, Bond R, Rothwell PM. Local versus general anesthesia for carotid endarterectomy. Cochrane Database Syst Rev. 2004;2. https://doi.org/10.1002/14651858.CD000126.pub2 DOI: https://doi.org/10.1002/14651858.CD000126.pub2

Gulur P, Nishimori M, Ballantyne JC. Regional anesthesia versus general anesthesia, morbidity and mortality. Best Prac Res ClAnaesthesiol. 2006;20(2):249-63. https://doi.org/10.1016/j.bpa.2005.10.002 DOI: https://doi.org/10.1016/j.bpa.2005.10.002

Yeap YL, Wolfe JW, Kroepfl E, Fridell J, Powelson JA. Transversusabdominis plane (TAP) block for laparoscopic live donor nephrectomy: Continuous catheter infusion provides no additional analgesic benefit over single?injection ropivacaine. Clin Transplant. 2020;34(6):e13861. https://doi.org/10.1155/2020/8914953 DOI: https://doi.org/10.1111/ctr.13861