Comparison of the efficacy of combined epidural anesthesia with general anaesthesia alone to attenuate hemodynamic responses and perioperative analgesia in laparoscopic cholecystectomy patients

Aishwarya Bandewar, Shweta Naik, Manish Kokne, Sugampreet kaur


Background: The aim of the study was to compare the efficacy of combined GA-Epidural Anesthesia (CEGA) with GA alone to attenuate hemodynamic responses and perioperative analgesia.

Method: Authors conducted a prospective, randomized, double blind study, in which 60 patients undergoing laparoscopic cholecystectomy. Group A received (n=30) received GA and Group B (n=30) received combined GA and Epidural Anaesthesia (CEGA). Authors analyzed the effect of combined epidural general anaesthesia as compared to plain general anaesthesia with regard to hemodynamic parameters (heart rate, systolic and diastolic blood pressure), intraoperative anaesthetic requirement (intraoperative requirement of propofol), recovery score and postoperative analgesia (VAS score).

Results: Authors found significant decrease in the heart rate, systolic and diastolic blood pressure in response to stress response to pneumoperitoneum in combined epidural general anaesthesia (CEGA) group compared to plain general anaesthesia (GA) group. Total amount of propofol required intraoperatively was less in CEGA group than in GA group. Recovery score and pain score (VAS) score were also compared which were better in CEGA group than in GA group. There were no significant intraoperative and postoperative complications noted in both the groups.

Conclusion: Authors concluded that the use of epidural along with general anaesthesia helps in attenuating hemodynamic changes due to stress response to pneumoperitoneum, which results in maintaining stable intraoperative and postoperative hemodynamics during laparoscopic cholecystectomy surgery. Combining epidural to general anaesthesia results in rapid recovery as compared to plain general anaesthesia and also helps in providing good postoperative analgesia.


Combined GA-epidural anesthesia, General anaesthesia, Postoperative analgesia

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Noirot D, Joris J, Legrend M, Lamy M. Hemodyanamic changes during pneumoperitoneum for laparoscopy cholecystectomy. Anesthesiol. 1992:77:A69.

Mclaughlin JG, Bonnell BW, Scheeres DE, Dean RJ. The adverse hemodynamic effects related to laparoscopic cholecystectomy. Anesthesiol. 1992:77:A70.

Hirvonen EA, Nuutinen LS, Kauko M. Hemodynamic changes due to Trendelenburg positioning and pneumoperitoneum during laparoscopic hysterectomy. Acta Anaesthesiol Scand. 1995;39(7):949-55.

Luchetti M, Effectiveness and safety of combined epidural and general anesthesia for laparoscopic cholecystectomy’. Regional Anesthesia. 1996;21(5):465-9.

De Grood PMRM, Harbers JBM, Van Egmond J, Crul JF. Anesthesia for laparoscopy: A comparison of Five techniques including propofol, etomidate, thiopentone, fentanyl and isoflurane. Anaesthesia. 1987;42:815-23.

Tripathi D, Shah K, Shah H. Hemodynamic stress response during laparoscopic cholecystectomy: effect of two different doses of intravenous clonidine premedication. J Anaesthesiol. 2011;27:475-80.

Mohamadreza G, Nesioonpur S, Foroosh FJ. Intravenous paracetamol for postoperative analgesia in laparoscopic cholecystectomy. Anesthesiol Pain Med. 2013;3(1):214-8.

Jean LJ. Anesthesia for laparoscopic surgery. In: Miller RD, eds. Anesthesia. 7th ed. New York: Churchill Livingstone; 2010: 2185-2202.

Ghodki P, Shalini P, Sardesai, Naphade R. Combined spinal and general anaesthesia is better than general anaesthesia alone for laparoscopic hysterectomy. Saudi J Anaesth. 2014;8(4):498-503.

Tzovaras G, Fafoulakis F, Pratsas K, Georgopoulou S, Stamatiou G, Hatzitheofilou C. Spinal vs general anesthesiafor laparoscopic cholecystectomy. Arch Surg. 2008;143(5):497-501.

Rigg JR, Jamrozik K, Myles PS, Silbert BS, Peyton PJ, Parsons RW, et al. Epidural anaesthesia and analgesia and outcome of major surgery: a randomised trial. Lancet. 2002;359:1276-82.

Erol DD, Yilwaz S, Polat C, Arikan Y. Efficacy of thoracic epidural analgesia for laparoscopy cholecystectomy. Pubmed Gov. 2008;25(1):45-52.

Baron JF, Bertrand M, Barré E, Godet G, Mundler O, Coriat P, et al. Combined epidural and general anesthesia versus general anesthesia for abdominal aortic surgery. Anesthesiol. 1991;75:611-16.

Suryavanshi V, Sahu A, Harde M. Efficacy of combined epidural general anaesthesia for attenuating haemodyanamic responses in gynaecological laparoscopic surgery. Int J Contemp Med Res. 2016;3(5):50-43.

Nizamoglu A, Salihoğlu Z, Bolayrl M. Effects of epidural-and-general anesthesia combined versus general anesthesia during laparoscopic adrenalectomy. Surg Laparosc Endosc Percutan Tech. 2011;21:372-9.

Pan YS, Hu YF, Tian FB, Xu K. Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study. Int J Clin Exp Med. 2015;8:9862-8.

Aono H, Takeda A, Tarver S, Goto H. Stress responses in three different anesthetic techniques for carbon dioxide laparoscopic cholecystectomy. J Clin Anesth. 1998;10(7):546-50.

Sotunmbi PT, Shittu OB, Windokun A, Eyelade OA. Combined general and epidural anaesthesia for excision of phaeochromocytoma--a unique and safe technique. African J Med Sci. 2000;29:319-22.

Danelli G, Berti M, Perotti V, Albertin A, Baccari P, Deni F, et al. Temperature control and recovery of bowel function after laparoscopic or laparotomic colorectal surgery in patients receiving combined epidural/general anesthesia and postoperative epidural analgesia. Anesthesia Analgesia. 2002;95:467-71.

Jogerson H, Fomsgaard JS, Dirks J, Wetterslev J, Andreasson B, Dahl JB. Effect of perioperative epidural anesthesia on pain and gastrointestinal function after abdominal hysterectomy. Brit J Anesthesia. 2001:87(4):577-83.

Pursnani KG, Bazza Y, Calleja M, Mughai MM. Laparoscopic cholecystectomyunder epidural anesthesia in patients with chronic respiratory disease. Surg Endosc. 1998;12(8):1082-4.

Gramatica L, Brasesco OE, Luna MA. Laparoscopic cholecystectomy performed under regional anesthesia in patients with obstructive pulmonary disease. Surg Endosc. 2002;16(3):472-5.

Lavandhomme P, De Kock M. The use of intraoperative epidural or spinal analgesia modulates postoperative hyperalgesia and reduces residual pain after major abdominal surgery. Acta Anaesthesiol. Belgium. 2006;57:373-9.

Koc H, Sivikaya GU, Hanci A, Dobrucali H. Comparison of the effects of combined general and epidural anesthesia on postoperative pain versus general anesthesia in total abdominal hysterectomy. Regional Anesthesia Pain Med. 2006;3(5):87.

Qu DM, Jin YF, Ye TH, Cui YS, Li SQ, Zhang ZY. The effects of general anesthesia combined with epidural anesthesia on the stress response in thoracic surgery. Zhonghua Yi Xue Za Zhi. 2003;83:408-11.

Dossow VV, Welte M, Zaune U, Martin E, Walter M, Rückert J, et al. Thoracic epidural anesthesia combined with general anesthesia: the preferred anesthetic technique for thoracic surgery. Anesthesia Analgesia. 2001;92:848-54.

Pan YS, Hu YF, Tian FB, Xu K. Effects of epidural preemptive analgesia on stress reaction in retroperitoneal laparoscopic adrenalectomy surgery: a randomized controlled study. Int J Clin Exp Med. 2015;8:9862-8.

Soto CP, Hernández TB, Contreras MA, Vásquez C. Comparison of combined spinal and general anesthesia block and combined epidural and general anesthesia block in laparoscopic cholecystectomy. Rev Invest Clin. 2009;61:482-8.

Bisgaard T, Kehlet H, Rosenberg J. Pain and convalescence after laparoscopic cholecystectomy. Eur J Surg. 2001;167:84-96.

Tekelioglu UY. The prolonged effect of pneumoperitoneum on cardiac autonomic functions during laparoscopic surgery; are we aware?. Euro Rev Med Pharmacol Sci. 2013;17:895-902.

Agarwal A. The effect of epidural bupivacaine on induction and maintenance doses of propofol (evaluated by bispectral index) and maintenance doses of fentanyl and vecuronium. Anesthesia Analgesia. 2004;99:1684- 8.