Findings from the Use of Spinal Anesthesia in the Laparoscopic Treatment of Extrauterine Pregnancy: Could It Represent an Alternative to General Anesthesia?

IF 2 4区医学 Q2 OBSTETRICS & GYNECOLOGY Gynecologic and Obstetric Investigation Pub Date : 2024-01-01 Epub Date: 2023-12-13 DOI:10.1159/000535778

Luigi Della Corte, Maria Chiara Guarino, Michela Dell'Aquila, Mario Ascione, Serena Guerra, Rossella De Rosa, Annaclaudia Del Piano, Dario Bruzzese, Giuseppe Bifulco, Pierluigi Giampaolino

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Abstract

Introduction: Minimally invasive procedures performed in laparoscopy, such as salpingectomy for ectopic pregnancy, can be combined with a minimally invasive anesthesia. The aim of this study was to assess the feasibility and the intraoperative and postoperative outcomes of laparoscopic surgery for ectopic pregnancy under spinal anesthesia (SA) compared to general anesthesia (GA) from the point of view of the surgeon, anesthesiologist, and patient.

Methods: A retrospective cohort study was performed at DAI Materno Infantile of AOU Federico II of Naples, analyzing all medical records of women who met the inclusion criteria between April 2020 and April 2023. Eighty-two women (35 under SA in group A and 47 under GA in group B) undergone elective or emergency laparoscopic salpingectomy for ectopic tubal or ovarian pregnancy were included.

Results: Patients in group A reported less pain at 0 h (adjusted mean difference: -1.5; 95% CI: -2.3 to -0.7; p < 0.001) and after 6 h (adjusted mean difference: -1.1; 95% CI: -2.0 to -0.3; p = 0.01) while no statistically significant differences between the two groups at 12 and 24 h after surgery. No differences were observed among the type of analgesic and during the postoperative observation time, except for paracetamol at 0 h in group B. A faster resumption of bowel motility, patient's mobilization, and a shorter hospital stay were observed in group A compared to group B. Also greater odds of returning faster to daily activities emerged in group A (adjusted OR: 5.39; 95% CI: 1.77-16.37). A greater number of patients in group A were satisfied with the entire procedure compared to those of group B (33 [94.3%] vs. 37 [78.7%]). The general surgeon satisfaction was always very good or excellent in group A. Finally, all surgical steps were well tolerated in group A.

Conclusion: In specific settings, SA is a feasible and safe procedure for the laparoscopic treatment of ectopic pregnancy.

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在腹腔镜治疗宫外孕过程中使用脊髓麻醉的结果：脊髓麻醉能否替代全身麻醉？

导言腹腔镜微创手术（如宫外孕输卵管切除术）可与微创麻醉相结合。本研究旨在从外科医生、麻醉师和患者的角度评估脊髓麻醉（SA）与全身麻醉（GA）下腹腔镜异位妊娠手术的可行性以及术中和术后效果：那不勒斯费德里科二世医院（AOU Federico II）妇幼保健院（DAI Materno Infantile）进行了一项回顾性队列研究，分析了2020年4月至2023年4月期间符合纳入标准的妇女的所有医疗记录。研究共纳入了82名因输卵管或卵巢异位妊娠而接受择期或急诊腹腔镜输卵管切除术的女性（A组35人接受SA手术，B组47人接受GA手术）：结果：A 组患者在 0 h 时的疼痛较轻（调整后的平均差异为-1.5；95% CI）：结果：A 组患者在 0 h 后的疼痛较轻（调整后的平均差异：-1.5；95% CI：-2.3 至 -0.7；p）：在特定情况下，腹腔镜手术治疗异位妊娠是一种可行且安全的方法。

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来源期刊

Gynecologic and Obstetric Investigation 医学-妇产科学

CiteScore

4.20

自引率

4.80%

发文量

审稿时长

6-12 weeks

期刊介绍： This journal covers the most active and promising areas of current research in gynecology and obstetrics. Invited, well-referenced reviews by noted experts keep readers in touch with the general framework and direction of international study. Original papers report selected experimental and clinical investigations in all fields related to gynecology, obstetrics and reproduction. Short communications are published to allow immediate discussion of new data. The international and interdisciplinary character of this periodical provides an avenue to less accessible sources and to worldwide research for investigators and practitioners.