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

Abstract

Abstract: Objective: To evaluate the feasibility of local anaesthesia instead of general anaesthesia in upper gastrointestinal abdominal procedures including open gastrostomy, gastrojejunostomy, gastroduodenal disjunction, jejunostomy and traction esophageal stenting. Materials and Methods: Department of Thoracic Surgery, Nishtar Medical University and Hospital Multan Pakistan, from September 1st, 2020 to December 31st, 2020. Total 147 patients were selected for the study, of which 80 patients were operated under local anaesthesia while 67 patients were operated under general anaesthesia. The procedures performed included open gastrostomy, gastrojejunostomy, gastroduodenal disjunction and feeding jejunostomy and traction rigid esophageal stenting. Age, BMI, gender, type of procedure performed, primary etiology, mean procedure time, stay in recovery, postoperative nausea and vomiting (PONV), postoperative pain at 4 hours, 8 hours and at 12 hours, postoperative sedation, postoperative patient discomfort, within 3 days postoperative mortality and within 7 days mortality were documented and compared between the two groups. Results: Mean age of the patients in group LA was significantly higher as compared to that of patients in group GA (p0.05). Procedure time and mean duration of stay in recovery was shorter in group LA (p<0.05). The incidence of PONV, complaint of postoperative pain at 4 and 8 hours, postoperative sedation and within 7-days mortality were significantly higher in group GA (p<0.05). Postoperative discomfort was also higher in group GA patients as compared too group LA patients (p=0.001). Conclusion: For performing various upper abdominal procedures, local anaesthesia is safe and a good alternative to general anaesthesia for the patients who are medically unfit for general anaesthesia. Moreover, local anaesthesia is associated with lesser adverse effects as compared to general anaesthesia. Patient is more comfortable and there is better pain relief in early postoperative period.

Keywords

• local anaesthesia, general anaesthesia, thoracic surgery, PONV (postoperative nausea and vomiting).