Laparoscopic cholecystectomy with thoracic epidural anesthesia and low-pressure pneumoperitoneum in patients with chronic obstructive pulmonary disease: A retrospective study

INTRODUCTION: General anesthesia-related side effects are more common in the presence of chronic obstructive pulmonary disease (COPD). Regional anesthesia techniques should be considered in these patients to reduce the risks. In this study, we aimed to retrospectively review our experience of laparoscopic cholecystectomy with thoracic epidural anesthesia, which we carried out in the COPD group.

METHODS: A total of 34 patients who underwent laparoscopic cholecystectomy operation under thoracic epidural anesthesia in our general surgery clinic between 2014 and 2018 were enrolled in this study. All patients had COPD with American Society of Anesthesiologist (ASA) III-IV.

RESULTS: All patients were successfully operated with low CO2 pneumoperitoneum (10 mmHg) under thoracic epidural anesthesia. Of all patients, 21 (61.8%) of them were male, and 13 (38.2%) of them were female with a mean age of 64 years (range: 52–76). Thirty-one (91.2%) of the patients had ASA III and 3 (8.8%) of them had ASA IV status. Analgesic was needed in 13 (38.2%) patients at the 6th hour and three (8.8%) patients at the 12th hour, while no analgesic was needed in any patients at the 24th hour. The most common complaint in the perioperative period was right shoulder pain by 35.2% (n=12). In addition, nausea occurred in 29.4% (n=10) of the patients; abdominal discomfort, or pain was noted in nine (26.5%) patients. In the per-op period, three (8.8%) patients developed hypotension and two patients (5.9%) bradycardia. In the post-op period, any complain was not observed in 14 (41.2%) patients, while 11 (32.5%) patients had nausea/vomiting, shoulder pain in four (11.8%), and abdominal discomfort was seen in four (11.8%). When pre- and post-op respiratory function tests were compared, no adverse effect was seen due to thoracic epidural anesthesia.

DISCUSSION AND CONCLUSION: COPD patients who are at a high risk of general anesthesia can be operated under regional anesthesia without experiencing respiratory system complications and with less post-op pain.