Outcomes and Complications of Spinal Anesthesia in Laparoscopic Cholecystectomy: A Prospective Study

Abstract

Background: Spinal anesthesia (SA) is increasingly being considered as an alternative to general anesthesia for laparoscopic cholecystectomy (LC), offering potential advantages such as reduced postoperative complications, shorter recovery time, and avoidance of endotracheal intubation. However, its widespread adoption in LC remains limited due to concerns about intraoperative complications and patient tolerance. This prospective study evaluates the clinical outcomes and complication profile of SA in patients undergoing elective LC. Objective: The primary objective was to assess the feasibility, hemodynamic stability, and perioperative complication rates of SA in LC. Secondary objectives included evaluation of intraoperative challenges (hypotension, shoulder pain, anxiety), postoperative recovery parameters, and patient outcomes. Methods: This prospective observational study employed purposive sampling to enroll 233 ASA physical status I-III patients undergoing elective LC under SA at a secondary-level urban hospital from January 2023 to December 2023. SA was performed at L1-L2 interspace using hyperbaric 0.5% bupivacaine (2.5-3.5 mL). LC was performed using the standard four-port technique with CO₂ pneumoperitoneum. Data were collected using structured proformas in MS Word and analyzed using SPSS version 23.0, with descriptive statistics for demographic variables and frequency distributions for outcome measures. Results: The study achieved a 97.4% spinal anesthesia success rate with 2.6% conversion to GA. Mean sensory blockade to T4 level occurred in 8.2±2.1 minutes. Intraoperative complications included hypotension (18.5%) and shoulder pain (22.3%), all managed successfully. Patients reported excellent pain control (mean VAS 2.1 at 2 hours) and high satisfaction (89%), with 92% discharged within 24 hours. Conclusion: This study strengthens evidence that SA is safe and effective for laparoscopic cholecystectomy when performed with modern protocols. The technique offers distinct recovery advantages while maintaining surgical conditions, warranting consideration in enhanced recovery programs.