Usefulness of epidural anesthesia in gynecologic laparoscopic surgery for infertility in comparison to general anesthesia

Background: Although the advantages of epidural anesthesia in open surgery have been established, its usefulness in the setting of laparoscopic surgery remains to be studied. Methods: Patients undergoing laparoscopic surgery for infertility were randomly administered epidural anesthesia (group A, n=11) or general anesthesia (group B, n=9). The operation was performed under 4 mmHg pneumoperitoneum and in the 20degrees Trendelenburg position. Respiratory function tests using a spirometer and blood gas analysis were performed during the intra- or perioperative period. Pain status was evaluated with visual analog scale scoring. The number of postoperative recovery days needed to resume daily activities was obtained by a questionnaire. Results: Respiratory rate, minute volume, PaCO2, % vital capacity (VC), and forced expiratory volume in 1 s (FEV1) % were virtually constant throughout the study period in group A, whereas %VC was decreased immediately after operation in group B (p<0.05). Minute volume immediately after operation was significantly increased in group B compared with group A (p<0.01), suggesting shallow respiration in women undergoing general anesthesia. Observed pain scores on abdominal pain, shoulder pain, and dyspnea were very low during operation in group A. Pain scores immediately and 3 It after operation were also minimal in group A, whereas abdominal pain scores at these points were significantly higher in group B than those in group A (both p<0.01). The number of days required for a half reduction in wound pain, trotting, and full recuperation for group A were less than those for group B (p<0.05). Conclusions: Epidural anesthesia, when used in laparoscppic surgery for infertility treatment, has advantages over general anesthesia in terms of analgesic effects, postoperative respiratory function, and a return to preoperative daily activities.