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AMBULATORY ANESTHESIA

Small-Dose Selective Spinal Anesthesia for Short-Duration Outpatient Laparoscopy: Recovery Characteristics Compared with Desflurane Anesthesia

Pamela H. Lennox, MB, BAO, BCh, MRCPI, FCARCSI^*, Himat Vaghadia, BSc, MBBS, MHSc, FRCPC, FFARCS^*, Cynthia Henderson, MD, FRCPC^*, Lynn Martin, MD, FRCPC^*, and G. W. E. Mitchell, MB, BCh, FRCOG, FRCS (Ed), FRCSC

Departments of *Anesthesia, Health Care and Epidemiology, and Gynecology, Vancouver General Hospital, University of British Columbia, Vancouver BC, Canada

Address correspondence and reprint requests to Dr. Himat Vaghadia, Department of Anesthesia, JPP 2449, Vancouver General Hospital, 855 West 12th Avenue, Vancouver, BC, Canada V5Z 1M9. Address e-mail to hvaghadi{at}vanhosp.bc.ca

We conducted a randomized controlled trial to compare the recovery characteristics of selective spinal anesthesia (SSA) and desflurane anesthesia (DES) in outpatient gynecological laparoscopy. Twenty ASA physical status I patients undergoing gynecological laparoscopy were randomized to receive either SSA with lidocaine 10 mg + sufentanil 10 µg or general anesthesia with DES and N₂O. Intraoperative conditions, recovery times, postanesthesia recovery scores, and postoperative outcomes were recorded. Intraoperative conditions were comparable in both groups. All patients in the SSA group were awake and oriented at the end of surgery, whereas patients in the DES group required 7 ± 2 min for extubation and orientation. SSA patients had a significantly shorter time to straight leg raising (3 ± 1 min versus 9 ± 4 min; P < 0.0001) and to ambulation (3 ± 0.9 min versus 59 ± 16 min; P < 0.0001) compared with the DES group. SSA patients had significantly less postoperative pain than DES patients (P < 0.05). We concluded that SSA was an effec-tive alternative to DES for outpatient gynecological laparoscopy.

IMPLICATIONS: This study compared the use of a desflurane general anesthetic to a small-dose spinal anesthetic in ambulatory gynecological laparoscopy. Using the spinal technique, patients can walk from the operating room table to a stretcher on completion of surgery. Their recovery time was similar to that of the desflurane group.

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