Efficacy of thoracic epidural analgesia for laparoscopic cholecystectomy

Introduction: Postoperative pain is a commonly observed phenomenon after laparoscopic procedures. The use of new low-solubility inhalation anaesthetics leads to faster induction and recovery, but the effect of analgesics on pain when used with them is not sufficiently known. Optimally, analgesic therapy should be started in sufficient time as to be effective at the point of emergence from anaesthesia. We compared the effectiveness of intravenous and epidural analgesia in patients undergoing general anaesthesia with sevoflurane for laparoscopic cholecystectomy in the early postoperative period. Methods: Thirty adult patients with American Society of Anesthesiologists (ASA) physical status I-II, scheduled for laparoscopic cholecystectomy, were enrolled in this study. The patients in the intravenous group (n=15) received general anaesthesia with sevoflurane and intravenous infusion of 1.5 mu g/ml/kg/h fentanyl analgesia followed by postoperative intravenous infusion of 1.0 mu g/ml/kg/h fentanyl, supplied by a programmed continuous analgesia pump. The patients in the epidural group (n=15) had combined epidural analgesia with 0.125% bupivacaine plus 50 mu g fentanyl and general anaesthesia with sevoflurane, followed by continuous epidural infusion of 4 ml/h bupivacaine 0.125% plus 50 mu g fentanyl. Visual analogue scores and the patients' needs for analgesics and were recorded. Results: Epidural analgesia with a bupivacaine/fentanyl combination provided a statistically and clinically significant improvement in postoperative pain control compared with intravenous analgesia during the first 24 h following laparoscopic cholecystectomy. Conclusion: The epidural technique provided a significant effect on postoperative pain in patients undergoing laparoscopic cholecystectomy.